Legal Acion & Alere / Avee

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Does anyone know anything about legal action between Horizon BCBS & Alere / Avee? I stumbled across a post on a website called Legal360. The post outlines some pretty serious complaints and legal actions with a case # & file date. I can’t locate ANY info anywhere else about this. I don’t want to apply for a position with Alere / Avee if they are in hot water over billing fraud. Does anyone know anything?
 






Uh, oh!!! Looks like some docs and treatment centers are going down for overuse of point of care cups and billing too. 36 million coming back to BC/BS of New Jersey, I'll wager:

http://floridahealthcarelawfirmblog....ting/#more-943

"The case is very instructive because imbedded in it are compliance related suggestions, some of which may not be apparent to many healthcare service providers, like:

Confirmatory testing of negative POCT results requires the healthcare provider has documented clinical reasons to believe the negative POCT was inaccurate or inconclusive.

Clinical labs must have a compliance program to detect and prevent healthcare providers from performing unnecessary POCT and ordering unnecessary confirmatory testing.

A clinical lab may not offer below market value POCT tests and consulting agreements in order to induce healthcare providers to refer tests.

Labs may not waive patient financial responsibility to induce healthcare providers to refer urine specimens to the lab."
 






Anonymous said:
Uh, oh!!! Looks like some docs and treatment centers are going down for overuse of point of care cups and billing too. 36 million coming back to BC/BS of New Jersey, I'll wager:

"The case is very instructive because imbedded in it are compliance related suggestions, some of which may not be apparent to many healthcare service providers, like:

Confirmatory testing of negative POCT results requires the healthcare provider has documented clinical reasons to believe the negative POCT was inaccurate or inconclusive.

Clinical labs must have a compliance program to detect and prevent healthcare providers from performing unnecessary POCT and ordering unnecessary confirmatory testing.

A clinical lab may not offer below market value POCT tests and consulting agreements in order to induce healthcare providers to refer tests.

Labs may not waive patient financial responsibility to induce healthcare providers to refer urine specimens to the lab."
Click to expand...

http://floridahealthcarelawfirmblog...-avee-attacks-point-of-care-testing/#more-943
 


















The law suit Horizon BCBS of NJ has against Avee/Alere has now moved into another phase. At first Avee/Alere was going to settle with Horizon…. Now Alere/Avee has decided to fight the law suit sighting there is no professional clinical standard for ordering toxicology testing (screening or confirmations).. Alere is asking Horizon where is Horizons clinical proof that too much testing was ordered or performed. Just because Horizon states too much testing was ordered doesn’t mean the ordering physician agrees. Alere/Avee is stating the frequency of testing depends on the level of treatment for each individual patient. Alere/Avee has decided to pay a panel of experts in the behavioral health / toxicology field to create an industry standard for ordering and performing toxicology screenings and confirmations. My questions is: How many insurance carriers, lawyers or healthcare professionals are going to take this panel’s recommendations serious? Alere/Avee is bankrolling the studies and the actual panel of experts. Seems to be a conflict of interest. Anyone in their right mind would think the experts are going recommend whatever Alere/Avee approves.
 






Going after the doctor and the facility is new. Thank God. Anyone who thinks testing a cup of piss for drugs should be more expensive than getting and an MRI or CAT Scan, and should be performed multiple times a month at that price, is not really looking out for the patient's best interest. Their collective wallets for sure, but no the patient.

"Horizon alleges Leading Edge Recovery Center and Dr. Deerfield, Leading Edge’s medical director, performed medically unnecessary POCT and confirmatory testing"

http://pathologyblawg.com/pathology...laboratories-others-urine-drug-testing-fraud/

Millennium got an honorable mention at the end too. House of cards, meet wind.
 












I have been billed by Avee for several negative poct (every POCT I TOOK) - see following letter







May 13, 2014

Todd S. Carran MD
The Ridge
50 West Technecenter Drive, Suite B-5
Milford, Ohio 45150

Dear Mr. Carran,

With all due respect, I do not consider your opinion(s), as stated in your letter of May 2, 2014, as a documented clinical reason(s) to repeatedly have confirmatory testing done on negative POCT’s. I feel that your standard procedure is to have all urine tests performed by your staff confirmed by an outside laboratory regardless of your results. Since the confirmatory tests have nothing to do with an individuals medical history or the results of your tests, it is simply a standard procedure that you follow as your letter states. It is solely based on the well-known phenomenon of Cross-addiction and the beliefs of the American Society of Addiction Medicine.

Given the fact that this is clearly your standard practice, it is not an “unknown” cost to your client(s) or their insurance companies, yet you fail to inform the patient of these costs to any reasonable extent. It would appear that you could test as often as you wish and then order confirmatory testing without any documented clinical reason to suspect that your results were possibly inaccurate or inconclusive.

After the first confirmatory test and your POCT were negative, I see no reason for you to believe that further POCT’s, would be different or to believe that my negative results were in fact inaccurate or inconclusive, requiring confirmatory testing. I also believe that you have failed to provide documented clinical reason to believe such. So in my case, as urine test after test were negative, your results were disregarded and the beliefs of the ASAM and the prior stated phenomenon were the only reason to order confirmatory tests, at a cost of over $1300.00 each.

It appears that you are asking me to believe that the level of care that you provided was heightened by the repeated confirmatory testing of numerous negative urine samples. It would appear to me that my care was lessened due to the fact that there apparently was little confidence in your negative results. It also appears that my treatment was based on the results of your “in house” tests because the results of some of the confirmatory testing was not even performed until well over a month into my stay at The Ridge (Aug 10 and 14, 2012). It is also apparent to me that your strategy of testing, and cost of such, did not align itself with the benefits. In fact, I would venture to say that in my case it was totally unnecessary and nothing more than a way to generate revenue.

The following is from the American Society of Addiction (Drug Testing: A White paper of the American Society of Addiction Medicine(ASAM) Adopted by the board of Directors 10/26/2103

Confirmation of presumptive positive results (and at times presumptive negative results) from laboratory or POC immunoassay tests is sometimes performed, potentially by GC-MS. Gas chromatography separates the different drugs or metabolites in a specimen, and mass spectrometry definitively identifies specific drugs or metabolites.28 GC-MS analysis typically

Smarter drug testing means careful consideration of the financial costs of testing in relationship to the value and in many cases, medical necessity, of the test results.

May 13, 2014
Todd S. Carran MD



This hardly seems to be a recommendation to confirm all test, let alone all negative tests.

I believe that it would be classified as insurance fraud to practice confirmatory testing without documented clinical reason(s) unless you believe that the point of care testing was not accurate. Especially with the Agreement that Aaron Stauckert stated The Ridge/Northland had with Avee Labs to not bill uninsured clients as long as they performed all your confirmatory testing on your POCT’s. It is my understanding that such an agreement may in fact be illegal and that there are currently lawsuits in the courts, regarding such agreements. If such agreement was in fact in place, and had Avee continued to honor this agreement, this would have never have come to my attention. Now that they decided not to honor this agreement, it is coming to light on the backs of the patients and insurance companies.

It should be noted that I was at The Ridge/Northland at my own expense and of my own free will, so to believe the possibility of cross addiction after repeated negative urine tests and my statement of such does not, in my opinion, require every urine test to be confirmed by an outside laboratory. At least not without a documented reason that you believed your results were not accurate or inconclusive. The fact that this is the general practice is not a clinical reason. It is simply a standard practice that is very monetarily lucrative. I find it unprofessional, and possibly illegal, that you bill several thousands of dollars for outside testing when you clearly knew the costs and had control of the frequency of the POCT’s and that you did not present these costs up front.

Again as provided by extent of law, I am requesting the documented clinical reason(s) to have each of my urine tests confirmed. If you are considering your letter written on May 2, 2014 as the documented clinical reason, or as stated simply as your procedure, and there is no documented medical clinical reason, please indicate such. As it stands, the letter can only be taken as a fact of your standard procedure and the basis of your opinion and the beliefs you chose to follow without any documented medical clinical support.

I understand that confirmatory testing provides a quantitative report on the samples tested, as were the POCT, for all practical purpose and only show the presence or lack of the drug(s) being tested for. When a negative result showing the lack of a drug(s) presence is in question, then a confirmatory test may be ordered. This would lead me to believe given my medical history and repeated negative results that you clearly, and without any medical reason, ordered confirmatory tests on all, or at least a large portion, of my urine samples. As I understand from your letter, this is in fact your procedure. With that said, at what point are your POCT’s used to determine treatment for your patients? Clearly you have no confidence in your negative POCT’s and to base treatments on such in my opinion is unprofessional.

Not only have I received bills recently for these tests but several more have been submitted. My insurance company has denied them for several reason including; unnecessary procedures, delay in billing and out of network. Any one of these is enough for denial of claim. Although Aaron Stuckert, along with John McCay, had expressed to me that the bill(s) are between me and Avee, I strongly disagree. These are based on what appears to be the ordering of the confirmatory test by your facility based on total disregard of your own testing results. Also for ordering confirmatory test without documented clinical reasons, and the apparent agreement you had with Avee Labs.

In case you are uncertain of my stance I will cleary state my position, as follows.

The costs to have confirmatory test performed are a result of your practice to have all urine tests confirmed regardless of your results. And to justify this practice by saying it provides a high standard of care is a smoke screen. I believe in my case, at minimum, it was medically unnecessary and was done out of routine as a way for you to get free tests on uninsured clients (along with quite possibly some other benefits) and has been brought to my attention only because Avee billed me unknowingly to you. I disagree that this bill is only between Myself and Avee Laboratories (Now Alere ) as you are responsible for requesting the confirmatory testing. I have no intention of paying these bills and want in writing confirmation that I will not be billed any further and the bills previously sent to myself will not be pursued any futher. If I am billed any further or any collecting is attempted I will not hesitate to take legal action, as the law provides.

Sincerely;
 
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