NJ says lab overcharged Medicaid by millions
By: Scott Fallon
NorthJersey.com
USA Today Network - New Jersey
..... A Pennsylvania laboratory overcharged New Jersey's Medicaid program by millions of dollars, including more than $1,000 to test urine for drugs, a test that it had charged other as little as $2.38 for, the State Comptroller;s official said Thursday. [10/03/2024]
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Atlantic Diagnostic Laboratories should pay New Jersey $7.3 million in refunds and civil penalties after an audit found questionable billing practices including those for drug tests that either were not ordered or lacked required documentation and signatures, according to a report from acting State Comptroller Kevin Waslsh.
..... The audit, which looked at claims form 2015 and 2018, found that Atlantic Diagnostic charged Medicaid as much as $1,035 per drug test. Medicaid ended up paying the Bucks County , Pennsylvania lab between $63.40 and $180.40 for the tests even though that lab charged others as little as $2.38, Walsh said.
..... "Laboratories are legally required to charge Medicaid the lowest possible rate and only conduct and bill for medically necessary tests," Walsh said in a statement. "By violating Medicaid rules and state Law, ADL was wasting taxpayer funds and draining resources form people who need them."
..... A representative for Atlantic Diagnostics did not return a phone call seeking comment Thursday [10/03/2024] morning.
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Of 261 billing samples analyzed by the Comptroller's Medicaid Fraud Division auditors found the lab violated one or more Medicaid regulations in each one.
..... The lab billed for test that were not approved by a physician or licensed practitioner, or tests that lacked required document ion or signatures in 88 of the 261 samples. The lab also "improperly unbundled claims," which often leads to a higher reimbursement rate, according to the audit.