CardioBrief: Rogue Lab's Unorthodox Billing Revealed

— Promised in writing to not bill patients, then changed its tune

by CardioBrief

MedpageToday

Records and emails newly posted on the web by a physician document the strategy used by a controversial new laboratory company to bypass laws and major safeguards designed to prevent fraud.

Nearly 2 years ago, it became known that the federal government was investigating Health Diagnostics Laboratory (HDL). That company, now bankrupt and out of business, was brought down by the government and major insurance companies for its illegal business practices. HDL bribed doctors to order its extremely expensive panels of tests, and then promised the doctors and their patients that the patients would not have to pay any co-payment or deductible fees.

Last year a new company -- True Health Diagnostics -- purchased the assets of HDL and almost immediately began to imitate and adapt HDL's questionable business practices. (True Health tried to bury its deep links to HDL and sought to help physicians set up physician owned labs which would allow them to profit from tests they performed.)

Now one physician, Debra Ravasia, MD, a women's health specialist in Spokane, Wash., has posted a record of her interactions since last fall with True Health. The documents provide an extraordinary amount of information about True Health's efforts to bypass the law. The story ends with her decision to stop using True Health 2 months ago.

After True Health bought HDL's assets in August 2015, Ravasia was contacted by a True Health representative, Julie Harding, who at first said there would be no changes in the company's billing policy, which involved "no out of pocket cost for the patient." Then, in October, Harding told Ravasia:

TrueHealth Diagnostics WOULD be sending invoices ... sometimes. She said they would send them up to three times. The patient had the choice to pay them or ignore them, depending on their financial situation, as assessed by the sole opinion of the patients (i.e., TrueHealth would not take any action to assess whether were or were not in a position to pay.) She further said there would be no collections process, and no harassing phone calls, ever.

In November 2015, Ravasia requested a written confirmation of this policy. Ravasia carefully recorded and documented her subsequent interactions with True Health:

Please click here to see the TrueHealth representative's response to this email inquiry. Julie's comments and confirmations are in red. Based on this conversation and email confirmation, we wrote a lab billing policy for patients, and sent it to TrueHealth to be sure that it was accurate and TrueHealth's representative confirmed that it did, in fact, accurately represent their policy. She further sent us a written document from TrueHealth, which clearly states "Up to three statements will be sent" and "No harassing phone calls."

The entire billing issue grew in importance in the subsequent months as it became clear that the HDL bankruptcy trustee had hired a collection agency to collect the missing co-payments from the thousands of HDL patients who had been promised they would never receive a bill. "This was very concerning to us," wrote Ravasia, because she had many patients who were now receiving large and entirely unexpected bills from the collection agency.

Ravasia again expressed her concerns to True Health and asked whether the policy of no payments would continue. But now, in the light of the growing publicity around the HDL case and published reports here and elsewhere about the scandal, True Health began to backtrack from its earlier position.

Her True Health salesperson's manager, Carol Nellis, told her that a similar situation would never happen with True Health:

Carol reassured us that TrueHealth was never going to get into similar trouble because their billing process was 100% compliant since they actually "invoiced patients and collected." We challenged that based on our verbal and written conversations with Julie. She said that "TrueHealth's policies are not really so different -- in fact, only different in a very subtle way." Carol claimed that we must have misunderstood what Julie said, and that Julie would never have said that patients didn't have to pay the patient portion of the invoices based on their own assessment of their ability to pay. She said that TrueHealth may very well bill patients and they were definitely expecting payment. We then sent Carol the email confirmations from Julie and the billing policy we had built in consultation with Julie based upon these verbal AND written communications from the TrueHealth representative. We asked Carol to state in writing if she also agreed that our written billing policy reflected TrueHealth's policy, and demanded written confirmation that their compliance department was in agreement as well.

We never heard from Carol again. Instead we were contacted by an attorney for TrueHealth Diagnostics, Regina Morano, on March 25, 2016, who provided a copy of TrueHealth's new billing policy that had apparently replaced the original one Julie gave us a few months prior to that, although this was the first time we were seeing that policy. We also heard directly from an attorney for TrueHealth Diagnostics in Chicago after that, from the law firm of Perkins Coie, whose name is Mike Osterhoff. With permission the phone conversation was recorded and a partial transcription of the conversation, held on April 8, 2016, as it pertains to this issue, can be seen here. In the end he did not write the letter to patients in the way he had told us he would in that conversation. Instead he wrote a much more superficial and, in our opinion, evasive letter. He told us that TrueHealth would be sending this letter to our patients.

On the website Ravasia reports that she is unaware of whether True Health has actually sent out this letter to her patients.

More CardioBrief Stories About HDL and True Health Diagnostics: