In Kentucky, five people have been charged by a federal grand jury for allegedly defrauding public health payers and insurers with a urine test scheme. Three of the five men are physicians and two are businessmen in Kentucky. According to the indictment they would bill for tests that were ineligible for reimbursement and may not have even been medically necessary.

The group was charged with one count of conspiracy, and 99 charges of health care fraud. Each charge was for one improper submission to Medicaid, Medicare, Anthem BlueCross BlueShield or Bluegrass Family Health.

The grand jury says that the businessmen owned a drug addiction treatment company called SelfRefind, which has 16 treatment locations in Kentucky and Ohio. They would ask patients to submit urine samples to make sure they were on the proper medications (and not on improper medications), and the samples would typically be tested at PremierTox which was a lab that the physicians shared the profits from. PremierTox did not have all of the equipment they needed to do certain tests so they would freeze and store the samples, and then test them months later when they got the equipment. At that point the tests may not have even been medically necessary, or the patients whose samples they were testing might not have been receiving treatment anymore. The lab would still bill for these tests and be reimbursed.

According to the indictment Medicaid could pay up to $1,100 for each test, and the five men each received around $600,000 from the lab’s profits and bought a condominium for $2 million. If they are convicted the government expects to be paid back an amount equivalent to the profits that each man made and they will take possession of the property the men bought.

The group plans to fight the charges. One of the physicians facing charges, Bryan S. Wood says that they did not do anything wrong. A defense attorney Mark Wohlander says that there is a misunderstanding on the part of the prosecutors who do not recognize how to treat drug addicts and do not know enough about the various kinds of drug tests that are performed in the course of such treatment.

“The charges are yet another example of the government attempting to interject itself into medical decisions made by qualified physicians,” said Wohlander.

The trial is set for December 1^st this year.