HARTFORD, Conn. — On Friday, Connecticut Attorney General William Tong announced a $1,729,977 settlement with Enzo Biochem, Inc. and its subsidiary Enzo Clinical Labs, Inc.
The settlement resolves allegations that the lab overbilled the Connecticut Medicaid program for testing services, violating the state False Claims Act.
According to Tong’s office, until its sale last year, Enzo ran a clinical lab testing facility in Farmingdale, N.Y., which served patients and healthcare practitioners in New York, New Jersey and Connecticut. As it was an enrolled Connecticut Medicaid provider, Enzo was required to adhere to state regulations prohibiting labs from billing Medicaid at higher rates than those billed to or accepted from other payers.
Between October 2019 and September 2021, Enzo billed the Connecticut Medicaid program full prices for testing services given at discounted rates for non-Medicaid patients, according to a Department of Social Services audit. Enzo was ordered to repay $981,951 to the state Medicaid program over time through withheld reimbursements.
Sparked by a whistleblower complaint, an investigation led by the Office of the Attorney General initiated in 2022 revealed that Enzo continued to overbill the state for testing services.
Tong’s office says that Friday’s settlement addresses both the outstanding audit repayment and new claims that came from the whistleblower investigation. Included in the civil settlement is the resolution of Connecticut’s claims brought under the qui tam or whistleblower provisions of the Connecticut False Claims Act.
According to those provisions, a private party can file an action on behalf of Connecticut and receive a portion of any recovery. Tong’s office says the realtor’s share from the proceeds of the settlement will be $238,369 and that the action is captioned United States of America, State of New York, and State of Connecticut, ex rel. Fraud Buster LLC v. Enzo Biochem, Inc. et al., No. 22-cv-07613, filed in the Southern District of New York.
Tong says that, as a Medicaid provider, Enzo was responsible for being aware of and following the law, including the requirement to bill Medicaid the lowest price charged or accepted from other payers.
“Enzo overcharged the state, was flagged in an audit, was forced to repay hundreds of thousands of dollars, and then continued to overcharge the state,” Tong said. “We are grateful to the Department of Social Services and the U.S. Attorney’s Office for the Southern District of New York for their collaboration in this case, as well as to the whistleblowers for the assistance and information provided.”
DSS Commissioner Andrea Barton Reeves added that the Office of Quality Assurance division within the Department of Social Services is committed to making sure Connecticut’s Medicaid program is never overcharged for services.
“The Department of Social Services is dedicated to ensuring that payments and billings are appropriate within the CMAP program and will continue to remain vigilant moving forward,” she added.
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Anyone who knows of suspected fraud or abuse in the public healthcare system is encouraged to contact the Attorney General’s Government Program Fraud Section at 860-808-5040 or by email at ag.fraud@ct.gov.
The Medicaid Fraud Control Unit of the Connecticut Chief State’s Attorney’s Office can also be reached at 860-258-5986 or by email at conndcj@ct.gov, and the Department of Social Services fraud reporting hotline can be reached by calling 1-800-842-2155, online at www.ct.gov/dss/reportingfraud or by email to providerfraud.dss@ct.gov.
Tong was assisted in this matter by Assistant Attorney General Eric Babbs, Forensic Fraud Examiner Lisa Bailey, Paralegal Orlean Woodham and Deputy Associate Attorney General Gregory O’Connell, who is chief of the Government Fraud Section.
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Dalton Zbierski is a digital content producer and writer at FOX61 News. He can be reached at dzbierski@FOX61.com.
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