Laboratory fraud involves billing Medicare or Medicaid for tests that were unnecessary, never performed, or ordered as a result of illegal kickback arrangements. If you work in a clinical laboratory, a healthcare organization that orders laboratory tests, or the laboratory industry and have witnessed any of these practices, you may have the basis for a qui tam case. Reach out for a confidential conversation. There is no obligation.
Laboratory fraud involves billing Medicare or Medicaid for tests that were unnecessary, never performed, or ordered as a result of illegal kickback arrangements. If you work in a clinical laboratory, a healthcare organization that orders laboratory tests, or the laboratory industry and have witnessed any of these practices, you may have the basis for a qui tam case. Reach out for a confidential conversation. There is no obligation.
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Clinical laboratories bill Medicare and Medicaid for diagnostic tests ordered by physicians and other healthcare providers. Laboratory fraud occurs when laboratories submit claims for tests that were not medically necessary, were never performed, or were ordered as a result of kickback arrangements that influenced the referring provider’s decision rather than the patient’s clinical need.
Because laboratory claims are submitted to Medicare or Medicaid, false claims in this area fall within the scope of the False Claims Act. Healthcare insiders, laboratory employees, and others with direct, first-hand knowledge of laboratory fraud may be eligible to file a qui tam lawsuit on behalf of the government and receive a share of any financial recovery.
Legal basis: 31 U.S.C. § 3729 (False Claims Act) | 42 U.S.C. § 1395 et seq. (Medicare) | 42 U.S.C. § 1320a-7b (Anti-Kickback Statute) | Source: uscode.house.gov
Laboratory fraud encompasses a range of schemes. The following are the most common types handled by this practice.
Unnecessary or Over-Testing: Billing Medicare or Medicaid for laboratory tests that were not medically necessary or were ordered in quantities that exceeded what the patient’s clinical condition required. This includes ordering panels of tests where only a subset were clinically indicated, or billing for confirmatory testing that was not ordered or clinically justified. In July 2026, Labcorp agreed to pay $14.5 million to resolve False Claims Act allegations that it submitted claims to Medicare for medically unnecessary urine drug testing conducted pursuant to a testing panel that included tests that were not individually ordered or medically necessary.
Laboratories Paying Kickbacks for Lab Service Referrals from Doctors: The Anti-Kickback Statute prohibits laboratories from paying remuneration to physicians or other referral sources in exchange for directing patients to the laboratory for testing. Kickbacks to referring physicians are frequently disguised as consulting fees, medical directorship arrangements, investment returns through management service organizations, or marketing commissions based on referral volume. Both the laboratory paying the kickback and the physician receiving it may be liable under the False Claims Act for the claims that result from those referrals.
Genetic Testing Schemes: Genetic testing fraud has been a sustained federal enforcement priority. Common schemes include billing Medicare for genetic tests that were not medically necessary, using marketers or telemedicine arrangements to generate large volumes of genetic testing orders without legitimate clinical need, and paying kickbacks to physicians or marketers to generate referrals for genetic tests. Employees of genetic testing laboratories, billing companies, and marketing organizations may have direct knowledge of these schemes.
False Laboratory Billing: Submitting claims to Medicare or Medicaid for laboratory tests that were never performed, billing under the provider number of a laboratory or physician who did not order or perform the test, or using incorrect billing codes to obtain a higher reimbursement than the test actually qualifies for. Billing staff and laboratory personnel who process claims are often in the best position to identify discrepancies between what was ordered, what was performed, and what was billed.
Legal basis: 31 U.S.C. § 3729(a)(1)(A) and § 3729(a)(1)(B) (False Claims Act) | 42 U.S.C. § 1320a-7b (Anti-Kickback Statute) | 42 U.S.C. § 1395 et seq. (Medicare) | Source: uscode.house.gov
The strongest laboratory fraud qui tam cases come from current or former employees who have direct, first-hand knowledge of the fraudulent conduct from inside the organization. This includes laboratory billing and coding staff who process claims they know to be inaccurate or for tests that were not performed, laboratory scientists and technicians who are aware of tests being billed that were not ordered or conducted, sales and marketing employees who know that referral payments or compensation arrangements violate the Anti-Kickback Statute, compliance officers who have identified billing or referral practices that do not comply with federal law, and physicians or clinical staff who have been offered or received remuneration in exchange for directing patients to a particular laboratory.
You do not need all the documentation before contacting us. If you have credible, first-hand knowledge of what you believe constitutes false claims to Medicare or Medicaid in connection with laboratory testing, that is enough to start a confidential conversation. We investigate thoroughly before asking for any commitment.
In fact, many former employees come forward with knowledge of fraudulent practices by their former employers after they have been demoted or terminated for complaining to their supervisors about the fraudulent practices or leaving their employment because they refuse to participate in the fraud.
Legal basis: 31 U.S.C. § 3730(b) (qui tam provisions) | Source: uscode.house.gov
Legal basis: 31 U.S.C. § 3730(h) (anti-retaliation) | 31 U.S.C. § 3730(b) (under seal filing) | Source: uscode.house.gov
Legal basis: 31 U.S.C. § 3730(d)(1) and § 3730(d)(2) | Source: uscode.house.gov
Arvind Bob Khurana has over 27 years of experience in complex litigation. We work on contingency. There is no upfront cost and no obligation to proceed.
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