Atlanta Gastroenterology Associates has agreed to pay $4.75 million to settle federal civil allegations that it took kickbacks and billed Medicare and other insurers for pathology testing that prosecutors say patients did not always need. The deal, announced Friday, focuses on a relationship with an Arkansas pathology company and the routine use of automatic “special stains” on biopsy samples. The settlement resolves civil claims only and does not include any admission of liability by the practice.
According to a Justice Department press release, federal officials say Atlanta Gastroenterology began working with Little Rock-based Advanced Pathology Solutions (APS) around May 2017 to design and run a limited-capacity pathology lab inside the practice’s offices. Under that arrangement, APS pathologists interpreted slides while the clinic billed for the technical component. Prosecutors allege APS provided benefits tied to building and operating the in-house lab and that Atlanta Gastroenterology agreed to send its specimens to APS exclusively. “This settlement reflects the Department’s commitment to protecting taxpayer money,” Assistant Attorney General Brett A. Shumate said in the announcement. The Justice Department said the relationship wrapped up around May 2020.
As reported by FOX 5 Atlanta, investigators say the clinic used a blanket or “reflex” ordering process that sent out special stains automatically, before a pathologist reviewed the routine stain or documented why the extra test was needed. The local outlet also notes that the settlement closes out civil allegations only and that there has been no court finding of liability.
How prosecutors say the lab setup worked
Government filings describe a division of labor in which histology technicians inside the Atlanta office prepared biopsy slides while APS handled the interpretations elsewhere. Prosecutors say that structure created a financial motive to keep referrals flowing and that the reflex ordering of special stains was one way the arrangement generated extra billable work…