On Monday, April 25, 2016, Plaintiffs UnitedHealthcare Insurance Company, UnitedHealthcare of Florida, Inc., and UnitedHealthcare Services, Inc. (collectively, “United”) filed a $50 million dollar lawsuit Complaint against Defendants Sky Toxicology, Ltd., Frontier Toxicology Ltd., Hill Country Toxicology, Ltd., Eclipse Toxicology, Ltd., Axis Diagnostics, Inc., Sky Toxicology Lab Management, LLC, FT Lab Management, LLC, Eclipse Lab Management, LLC, William “Wade” White, M.D., Lance Hupfeld, Bradley West, Elements Behavioral Health, Inc., Solid Landings, LLC, South Florida Recovery Center, LLC, Kory Avarell, Stephen Fennelly, Elizabeth Perry, Ferriel Consulting Group, Inc., Jeffrey L. Cohen, and LLJ Consultants, Inc., in a 57-page lawsuit.
In this suit (a copy of which is attached), United is claiming the Defendants, who are alleged to be the executives and owners of the labs in question, “execute[d] a scheme to defraud private payors, like United, through a pattern of deceptive and unfair trade practices related to health insurance claims for urinalysis (UA) tests; offer[ed] kickbacks to Referring Defendants who are in position to refer, or cause to be referred, large quantities of UA tests;” disguised kickbacks as “investments” by purchasing limited partnership shares in the lab to which they refer UA tests, and to which the referring entities would then receive monthly distributions of “tens of thousands of dollars, based on their limited partnership shares.”
However, if the referrals stopped or decreased, United alleged that the individual defendants “threaten[ed] to buy back the Referring Defendants’ shares or withhold their monthly distributions; encourage[d], instruct[ed], and demand[ed] that Referring Defendants increase the number of UA tests sent to Lab Defendants through the referral of unnecessary and/or unauthorized UA tests.”
The Complaint further alleges the “systemic waiver of United’s members’ payment responsibilities” and that United made “payments to Lab Defendants based on the fraudulent claims and then Individual Defendants funnel[ed] the money back to the Referring Defendants and themselves through limited partnership shares in Lab Defendants and/or their respective general partner.”
As a result, the Complaint concludes that “Defendants have created and utilize myriad entities to disguise and add layers to the kickback scheme, which is calculated to make tracing funds more difficult.”
The matter can be found as Case No. 9:16-cv-80649-RLR in the United States District Court for Southern District of Florida.
This is the second such lawsuit of which we are aware against Sky Toxicology, the first coming by Cigna.
We have no information on the veracity of any of the allegations made in the pleadings.Click here to read more.