Unnecessary Breast Cancer Testing Fraud Settlement
A company will pay around $2 million to settle allegations of making false claims to Medicare for Breast Cancer Index (BCI) tests that were alleged to be not reasonable and necessary for the diagnosis and treatment of breast cancer.
The government accused the company of knowingly promoting and performing BCI testing for breast cancer patients who had not been in remission for five years and who had not been taking tamoxifen. The government alleged that performing BCI testing under these circumstances was not reasonable and necessary based on published clinical trial data and clinical practice guidelines.
This case highlights the need to assure that there is clinical support for providing and billing for services. In this case, the government took the position that patients who did not meet certain criteria would not benefit from the BCI testing.
Source: Health Law Blog