A Washington State urgent care company operating multiple clinics across several cities recently agreed to pay $2.8 million to settle allegations tied to improper billing for diagnostic testing. In a new Deeper Than the Headlines segment, Healthicity’s CJ Wolf, MD, explains what went wrong—and why it matters for every compliance team.
At the center of the case were PCR respiratory pathogen panels and UTI pathogen panels. These tests are designed to run multiple diagnostics on a single patient specimen. Under proper billing rules, panels are billed as a single, comprehensive code. But investigators alleged that the clinics were unbundling—billing each component test separately instead of as one. That approach results in significantly higher reimbursement and violates proper coding principles.
The complaint went a step further. Washington’s Medicaid program argued that some of the tests weren’t medically necessary, meaning they may not have been needed for patient care in the first place.
The takeaway? Organizations handling lab testing must ensure:
- Correct coding and bundling rules are followed
- Medical necessity is documented and defensible
- Billing practices align with state and federal requirements
It’s another reminder that compliance issues don’t only happen at large health systems—smaller, multi-site clinics face the same level of scrutiny.
Healthicity
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