A Mass.-based laboratory-testing service and its owners paid more than $1.5 million to resolve allegations that they overbilled Connecticut’s Medicaid program, prosecutors say.
Clinical Science Laboratory Inc. (CSL), of Mansfield, Mass., and its owners Stanley Elfbaum and Louis Amoruso entered into a civil settlement agreement with the federal and state governments after being accused of violating Connecticut’s so-called “Most Favored Nation” regulation, the Connecticut U.S. Attorney’s Office said Thursday.
Medicaid regulations mandate that clinical laboratories should not seek payment from Connecticut Medicaid for services at a price that is higher than the lower price the laboratory charges for the same or similar service from other third parties.
For example, government officials allege that CSL often accepted payments from Connecticut Medicaid for urine drug screen testing at a price of $38 per test, while also billing substance abuse treatment clinics approximately $2 per test.
Under the settlement, CSL and its owners agreed to pay over $1.5 million to cover claims submitted to the Connecticut Medicaid program from Oct. 1, 2016 through May 23, 2017.
“Clinical Science Laboratory was billing the state’s Medicaid program 19 times what it charged to other customers — diverting taxpayer resources away from other critical needs,” said Attorney General William Tong. “Connecticut has been disproportionately devastated by the opioid epidemic, and we must ensure we are getting the absolute most out of every treatment dollar spent.”
In a statement later Friday, CSL said it negotiated a settlement to avoid a costly litigation battle, adding that they admitted no wrongdoing in the matter.
“The government did not allege, as it could not, that CSL billed Medicaid or anyone else for a drug test that was not properly authorized and correctly performed,” the company said. “CSL simply wanted to help assure that all patients receive the treatment and care they need and deserve.”
The case was investigated by the Office of Inspector General for the U.S. Department of Health and Human Services.
This story has been updated to include comment from CSL
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