Grand Rapids Reporter

U.S. Attorney for the Western District of Michigan, Mark Totten, announced that Physicians Toxicology Laboratory, LLC (PTL) from Tampa, Florida, has agreed to a $4.425 million settlement. The settlement resolves allegations under the False Claims Act (FCA) that PTL caused physicians to order unnecessary urine drug and hormone tests and submitted claims for reimbursement to Medicare. Lund Capital Group, LLC, PTL’s former president Matthew Ryan Lund, and Thomas C. Lund are co-defendants in this case.

"Lab tests should be ordered based on each patient’s medical needs and not just to increase laboratory profits," stated U.S. Attorney Mark Totten. "Laboratories and ordering practitioners must play by the rules."

The United States alleges that PTL provided services for several Michigan medical practices which ordered two types of urine drug tests (UDTs): presumptive and definitive. These orders were allegedly made without individualized determinations of medical necessity.

Medicare requires UDT claims to be based on individual assessments rather than blanket orders. However, from January 1, 2017, through December 31, 2019, PTL is accused of encouraging blanket orders by creating requisition forms for both test types simultaneously and employing in-office urine collectors who filled out these orders.

Furthermore, it is alleged that PTL billed Medicare for hormone level urine tests as part of specimen validity testing already covered under UDT costs.

Previously settled FCA liability allegations involved two Michigan practices: Family Health Partners, P.C., owned by Michael J. Septer D.O., and Advanced Pain Solutions PLLC d/b/a Vitruvian Health.

As part of the settlement agreement with PTL and its affiliates including Lund Capital Group and Matthew Ryan Lund among others entered into a three-year Integrity Agreement with the Department of Health and Human Services Office of Inspector General (HHS-OIG). This agreement mandates a compliance program overseen by a clinical director who reviews policies related to clinical decision-making.

"Health care providers are expected to follow the rules...but knowingly submitting claims for medically unnecessary services violates that trust," said Mario M. Pinto from HHS-OIG.

This resolution was achieved through collaboration between the U.S. Attorney’s Office for the Western District of Michigan and HHS-OIG with Assistant United States Attorney Andrew J. Hull along with Senior Trial Counsel Christopher Terranova prosecuting this case.

The resolved claims remain allegations without any determination of liability.