One of the most frequent problems we encounter during our audits of physician practices is the structure of the practice’s urine drug testing program. We all know that the CDC guidelines and many state regulations require practices prescribing controlled substances to conduct a urine drug test on nearly all patients at regular intervals. In typical government fashion, the Government is taking a swing at providers who are testing too much in the form of civil and criminal action. Anecdotally, as a litigator I am leading the defense of a number of physicians who are on the wrong end of federal healthcare audits for doing what they thought was the right thing, conducting urine drug tests and confirming the results. That’s why I founded CCG – to give you the right compliance advice before you are the target of federal scrutiny. Our goal is to help steer practices in the right direction BEFORE the federal government starts poking around – or worse! Here’s how you can avoid civil and criminal investigation related to your urine drug testing program.

But first, a case study.

On October 20, 2021 MD Labs and its Co-Founders agreed to pay up to $16 million to resolve allegations of fraudulent billing related to urine drug tests. Denis Grizelk and Matthew Rutledge (the owners) have agreed to pay $16 million to resolve a pending civil case brought by the department of justice. What offense was there? Conducting a presumptive urine drug test in order to get quick qualitative results and then immediately conduct a confirmatory test designed to quantify those results and provide actual information that can be used to further patient care. The Government claims that the owners knew that doctors would not review presumptive urine drug testing results when they already had the more precise confirmatory results and that absent a presumptive UDT result there was nothing to confirm. 

This Government logic evades reality.

As many doctors know, a lot can be gleaned from confirming a presumptive result. Let’s take the example of a patient who is prescribed Oxycodone for pain management. The patient comes to the doctors office and gets a monthly presumptive test that can be immediately read by the provider to see if the medication is in their system or if there are any illicit drugs in their system. The patient can be counseled appropriately and a more limited dose of medication could be prescribed while the provider awaits the results of the confirmatory test. Presumptive UDT tests not reliable and often confirmatory results reveal the presence of medication despite negative presumptive results. Therefore a confirmatory result is often necessary especially where patients are high risk. Additionally, presumptive results generally only reveal the presence or absence of opiates but fail to tell a provider if those results are from heroin or oxycodone. Even with a positive presumptive result for opiates a further test should be conducted in high-risk patients to determine if the patient is taking the medication or if the positive result is from an illicit drug or a drug that wasn’t prescribed. 

So how can we defend this new form of government scrutiny? 

Providers must have a clear urine drug testing policy that stratifies risk. We can help you with that. Patients must be placed in a risk category and tested accordingly. Patients with higher risk should be tested more frequently and have their results confirmed more frequently. Patients with a lower risk may be tested only once a year or in other appropriate intervals. When a presumptive test is done it should be documented in the patient file and the need for a confirmatory test should also be documented in the patient record. 

Do you need help with your urine drug testing program? 

If you need help setting up, modifying or training staff on your drug testing protocols we have you covered. Our expert compliance consultants have government healthcare audit and investigation experience and know the gaps that the government is looking for. We can set up your protocol, train your staff, and ensure your urine drug testing program is ironclad and not subject to government scrutiny. Don’t wait for a costly government audit, civil suit, or potential criminal sanction. Give us a call today so that we can help you achieve ironclad compliance and allow you to do what you do best – practice medicine!