DALLAS – UnitedHealthcare Insurance was used in a massive fraudulent billing scheme, the company claimed in a Texas court.
United filed a case against Next Health and its subsidiaries United Toxicology, Medicus Laboratories, US Toxicology, American Laboratories and Erik Bugen and Kirk Zajac in the U.S. District Court Northern District of Texas on Jan. 26.
United is a health service provider that, among many other services, provides reimbursement to its members when the member uses out-of-network (OON) providers. Next Health and its subsidiaries are OON providers that regularly submitted claims on behalf of the patients for medical testing.
According to the case, “Pursuant to Texas law, OON providers such as Next Health, Medicus, US Toxicology, ALG and UTox must refrain from balance-billing members for improper, fraudulent, or unreasonable fees, and comply with mandated notice and disclosure requirements.”
Next Health is controlled by Semyon Narosov and Andrew Hillman. Both Narosov and Hillman were, according to the case, “indicted in connection with a conspiracy to pay and receive health care bribes and kickbacks at Forest Park Medical Center,” and controlled US Health Group which was part of a qui tam suit in 2013.
US Health Group and Next Health have the same subsidiaries.
Next Health was allegedly charging much more than an average OON for common medical tests. For example, a drug screen qualitative would usually cost $890 through an OON. Next Health was allegedly charging $1,512 for the same test.
Since 2011, Next Health and its subsidiaries purportedly have submitted 136,000 claims to United and United has paid out more than $100 million for the claims.
“Next Health makes payments (or promises to make payments) to medical providers in exchange for collecting urine and saliva specimens and submitting the specimens to Next Health for ancillary testing services,” the case states.
In addition, the case states Next Health, “incentivize[d] sales consultants, third-party contractors, and others who cause urine and saliva specimens to be sent to Next Health for ancillary testing services.”
These third-party contractors would allow Next Health to use their testing request forms without their signatures legitimizing them, the suit states.
Next Health was allegedly submitting an extreme amount of claims for large amounts of money to United. Between July 2016 and September 2016, United was billed nearly $1 million for drug tests from a chiropractor, someone who wouldn’t normally request drug tests, the suit states.
“Between 2011 and mid- 2016, Next Health and its subsidiaries submitted thousands of claims to United, charging more than $400 million for out-of-network drug and pharmaco-genetic laboratory testing services,” the case states.
United is seeking injunctive relief, damages and declarative relief.
United is represented by Stephen Mooney of Weinberg Wheeler Hudgins Gunn & Dial from Atlanta and Andrew Jubinsky and Raymond Earl Walker of Figari & Davenport from Dallas.
The case is being heard by Chief Judge Barbara Lynn.