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Carolinas HealthCare to pay $6.5 million for fraudulent billing practices

August 2, 2017

Carolinas HealthCare has agreed to pay millions of dollars to settle a whistleblower lawsuit in which state and federal prosecutors also agreed to take part.

The lawsuit was filed by Mark McGuire, who is the laboratory director of operations at the Carolinas Medical Center in Charlotte, according to the legal complaint. McGuire’s complaint alleges the hospital system was over-billing the federal government for urine screening tests.

McGuire spent months trying to alert supervisors and hospital staff about the billing error to no avail, according to the complaint.

According to court documents, from 2011 to 2015, CHS conducted urine drug tests, categorized as “moderate complexity” tests by the Food and Drug Administration (FDA), but submitted claims that indicated the company had conducted “high complexity” tests.  Claims submitted to federal health care programs include a code that identifies the services provided and that triggers a certain payment.

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