Kentucky lab owner admits to defrauding Humana, Aetna, Anthem

The owner of a toxicology lab in Kentucky pleaded guilty for his role in a conspiracy that defrauded health insurers of more than $1.3 million, according to the Department of Justice.

Dinesh Goyal, owner of Owensboro, Ky.-based Tristate Medical Laboratory, falsely submitted billing information to Kentucky's Medicaid program that made it look like urine drug tests completed outside of his facility were performed at Tristate. Mr. Goyal was falsely billing tests for two co-conspirators, who were restricted from filing claims due to concern over their legitimacy.

Through the scheme, Mr. Goyal received 40 percent of the fraudulent claims. The fraudulent claims were filed to Humana CareSource, Aetna Coventry Cares and Anthem Blue Cross & Blue Shield Medicaid plans.

In addition to Mr. Goyal's guilty plea, he entered a separate settlement to resolve his civil liability under the False Claims Act. Under that agreement, Mr. Goyal agreed to sell his personal and commercial property and remit 75 percent of sales to the U.S., as well as be excluded from the Medicare and Kentucky Medicaid program for 10 years.

One of Mr. Goyal's co-conspirators pleaded guilty to the same offense and the other died unexpectedly in August 2017.

More articles on payers:
UnitedHealth needs to shore up mental health coverage, plaintiffs argue
Las Vegas hospital will have to contract with Medicare, Medicaid by 2021
Massachusetts residents bought fake health insurance, state says

© Copyright ASC COMMUNICATIONS 2019. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 

Top 40 Articles from the Past 6 Months