$370
Million
Judgment Obtained Against Tokoma Lab for Fraudulent Lab Billing
Our client, Jacqueline Cushing, filed her complaint pursuant to the False Claims Act (“FCA”) almost four years ago in December of 2019. Her FCA case has now resulted in a $371,489,616 damages award through a default judgment entered on September 21, 2023 against Tomoka Medical Lab, Inc.; Rajen Shah; Golden Rule Management, LLC; Tennessee Valley Regional Laboratory, LLC; Luminus Diagnostics, LLC; and United Diagnostics, LLC (“Defendants”) for laboratory testing fraud. Specifically, Defendants were causing false claims to be submitted to federal healthcare programs for laboratory services that were not ordered by a licensed healthcare provider.
Ms. Cushing worked as the Operations Manager for Tomoka Medical Lab, Inc. in Ormond Beach, Florida. Shortly after she began working there in August of 2019, she soon realized that when a patient’s healthcare provider ordered a basic urinalysis with a culture and sensitivity, Defendants would routinely disobey the order and instead direct the laboratory to perform and bill for a much more profitable Urine PCR test. The CMS reimbursement for a standard urinalysis with culture and sensitivity is approximately $20. The CMS reimbursement for a Urine PCR is approximately between $450 – $500. After investigating Defendants’ improper practices further, Ms. Cushing learned that this fraud was not limited to the laboratory locations in Florida, but also was happening at laboratories outside of the State of Florida as well.
As soon as Ms. Cushing became aware of the fraud, she reported it internally and took steps to try to rectify the Defendants’ improper practices. Unfortunately, the Defendants made it clear that they had no intention of correcting their practices. It was at that point that Ms. Cushing contacted our law firm and promptly filed her FCA complaint. Her efforts have assisted the Government in putting a stop to a multi-state fraud that was causing Government healthcare programs hundreds of millions of dollars in damages.