We are a bit late in reporting this ruling, but in March Natera settled with the US government for over $11 million to resolve claims of fraudulent billing for its Panorama prenatal cfDNA screening test. The government held that from 2013 through 2016, Natera knowingly submitted improper claims for payment from TRICARE (the insurance program for the US military), the Federal Employees Health Benefits Program, and Medicaid. By using improper billing codes, Natera misrepresented the services for which they were billing, causing these agencies to pay for testing that they would not otherwise cover – such as cfDNA screening for low-risk pregnancies and for microdeletion syndromes.
The Department of Defense, Office of the Inspector General, Defense Criminal Investigative Services (DCIS) and the Defense Health Agency (DHA) investigated the charges in response to a whistleblower complaint filed in the US District Court for the Western District of Kentucky (United States, ex rel. Sallie McAdoo and Steven Aldridge v. Natera, Inc., Civil Action No. 3:15-cv-88-DJH). Vice Adm. Raquel Bono of the Defense Health Agency (which manages TRICARE) said, “I applaud the Department of Justice and the U.S. Attorney for their untiring efforts to hold health care providers accountable to the American taxpayer.” We are particularly pleased to report that our colleague Mark Leach represented the whistleblowers in this suit, and helped to bring this case to a just settlement.