State of Connecticut Office of the Attorney General

09/20/2024 | Press release | Distributed by Public on 09/20/2024 11:31

Attorney General Tong Announces $1.7 Million False Claims Settlement With Enzo Clinical Labs

Press Releases

09/20/2024

Attorney General Tong Announces $1.7 Million False Claims Settlement With Enzo Clinical Labs

(Hartford, CT) - Attorney General William Tong today announced a $1,729,977 settlement with Enzo Biochem, Inc. and its subsidiary Enzo Clinical Labs, Inc., resolving allegations that the lab overbilled the Connecticut Medicaid program for testing services in violation of the state False Claims Act.

Until its sale in 2023, Enzo operated a clinical lab testing facility in Farmingdale, New York, serving patients and healthcare practitioners in New York, New Jersey, and Connecticut. Enzo was an enrolled Connecticut Medicaid provider, and required to comply with state regulations that prohibit labs from billing Medicaid at higher rates than those billed to or accepted from other payers.

A Department of Social Services audit found that between October 2019 and September 2021, Enzo billed the Connecticut Medicaid program full prices for testing services provided at discounted rates for non-Medicaid patients. Enzo was ordered to gradually repay $981,951 to the state Medicaid program through withheld reimbursements. Starting in 2022, triggered by a whistleblower complaint, an investigation conducted by the Office of the Attorney General found that Enzo had continued to overbill the state for testing services.

Today's settlement addresses both the outstanding audit repayment, as well as new claims arising from the whistleblower investigation. The civil settlement includes the resolution of Connecticut's claims brought under the qui tam or whistleblower provisions of the Connecticut False Claims Act. Under those provisions, a private party can file an action on behalf of Connecticut and receive a portion of any recovery. The relator's share from the proceeds of the settlement will be $238,369. The action is captioned United States of America, State of New York, and State of Connecticut, ex rel. Fraud Buster LLC v. Enzo Biochem, Inc. et al., No. 22-cv-07613, filed in the Southern District of New York.

"As a Medicaid provider, Enzo was responsible for knowing and following the law, including the requirement to bill Medicaid the lowest price charged or accepted from other payers. Enzo overcharged the state, was flagged in an audit, was forced to repay hundreds of thousands of dollars, and then continued to overcharge the state. We are grateful to the Department of Social Services and the U.S. Attorney's Office for the Southern District of New York for their collaboration in this case, as well as to the whistleblowers for the assistance and information provided," said Attorney General Tong.

"The Office of Quality Assurance division within the Department of Social Services is committed to ensuring Connecticut's Medicaid program is never overcharged for services," DSS Commissioner Andrea Barton Reeves said. "The Department of Social Services is dedicated to ensuring that payments and billings are appropriate within the CMAP program and will continue to remain vigilant moving forward."

Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Attorney General's Government Program Fraud Section at 860-808-5040 or by email at [email protected]; the Medicaid Fraud Control Unit of the Connecticut Chief State's Attorney's Office at 860-258-5986 or by email at [email protected]; or the Department of Social Services fraud reporting hotline at 1-800-842-2155, online at www.ct.gov/dss/reportingfraud, or by email to [email protected].

Assistant Attorney General Eric Babbs, Forensic Fraud Examiner Lisa Bailey, Paralegal Orlean Woodham, and Deputy Associate Attorney General Gregory O'Connell, Chief of the Government Fraud Section, assisted the Attorney General in this matter.
Twitter: @AGWilliamTongFacebook: CT Attorney General

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