NOTICE: If you witness COVID-19 testing or treatment fraud, you may be able to help. Contact the Arnold Law Firm at (916) 777-7777 for a confidential evaluation.
Nearly 70 million COVID-19 tests have been reported in the United States. COVID-19 testing and developments in treatment are imperative for overcoming the coronavirus pandemic and getting daily life back on track. Significant government funding has been directed for COVID-19 diagnosis and therapeutics.
There are two types of COVID-19 tests: virus and antibody. The virus test uses swab samples from your respiratory system to diagnose a current COVID-19 infection. The antibody test uses a blood sample and does not diagnose an active infection. Instead, it provides information about whether you have been infected with COVID-19 in the past.
Currently, there are no tests that have been formally approved by the Food and Drug Administration (FDA) to diagnose COVID-19. Some tests have an Emergency Use Authorization (EUA), but companies may not legitimately claim that any test is FDA-approved.
The U.S. Department of Health and Human Services (HHS) provides COVID-19 tests at no cost through health centers and designated pharmacies. Both public and private insurances are required to cover authorized COVID-19 tests, providing the health care provider determines that the test is medically appropriate.
The Coronavirus Aid, Relief and Economic Security (CARES) Act requires private insurance to fully cover COVID-19 tests and publish reimbursement rates for out-of-network claims on a public website. However, out-of-network providers are permitted to bill patients directly for a COVID-19 test.
Medicare reportedly reimburses providers up to $100 per COVID-19 test. Private insurance cost of the test may vary depending on the type of test used, the individual’s insurance plan, and whether the test is performed during intensive care. Private insurance charges for a COVID-19 test reportedly range from $199 to $6400.
Unfortunately, some health care providers are unethically taking advantage of the crisis, and fraud schemes are rapidly evolving. Potential indicators of fraudulent activity include:
In mid-March 2020, health care technology company Arrayit allegedly sent out a promotional email about a test that accurately detected the coronavirus in dried blood samples and directed medical clinics to bundle the test with its allergy diagnostic, regardless of medical need.
According to DOJ, no such Arrayit product existed at the time of the claim. Reportedly, the company ordered COVID-19 antigens on the very day the emails were sent out with the intention of developing the test.
Arrayit’s directive to bundle the tests also allegedly led to false and fraudulent claims for an unrelated and far more expensive allergy test for 120 allergens. Arrayit billed for allergy testing that doctors had not ordered.
After the test was developed, Arrayit allegedly did not disclose that it failed to satisfy FDA performance standards for obtaining an emergency use authorization.
The DOJ has charged Mark Schena, the president of Arrayit, with the alleged submission of $69 million in false claims for COVID-19 and allergy tests.
If you observe fraud by an individual or company that causes losses to the government, such as COVID-19 testing fraud or misuse of CARES Act funds or another government program, you may be able to help.
The False Claims Act (FCA), 31 U.S.C. 3729 et seq, gives a private individual the right to bring a claim on behalf of the government against any person who knowingly submits or causes to submit a false or fraudulent claim to the United States.
The trial lawyers at the Arnold Law Firm in Sacramento have extensive experience handling intricate and delicate qui tam (also known as “whistleblower”) civil lawsuits successfully. Our firm maintains the highest levels of discretion and advises potential whistleblowers about their options.
For additional information about fraudulent COVID-19 testing concerns, see Physicians Practice article, “COVID Testing: What’s appropriate and what’s not,” co-authored by Arnold Law Firm attorney, M. Anderson Berry.
Contact the Arnold Law Firm at (916) 777-7777 for a confidential evaluation.