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Oh, This Code

The US Federal Bureau of Investigation is examining the billing codes used by uBiome and whether the company sought payment for unneeded tests, the Wall Street Journal reports. It adds that the agency is also examining the role of the doctors who ordered the uBiome tests.

The FBI searched uBiome's offices in April as part of its investigation into its billing practices, leading the company to place Jessica Richman and Zac Apte, the co-CEOs and founders of the company, on administrative leave and launch an independent investigation of its billing practices. It then suspended some of its clinical operations.

The Journal reports that it has reviewed documents from three patients whose insurers were billed for a uBiome test and experts tell it that incorrect billing codes were used. For instance, it says that the firm billed for testing a dozen to two dozen gastrointestinal pathogens using a particular approach, while its the SmartGut test only tests for five pathogens, among a number of other microorganisms, using a different technique. The billing code used, the Journal reports, is typically reimbursed at a higher rate.

Pathologist Roger Klein tells it that the firm should have used a code for procedures that don't have their own code or should have sought a specialized code.

"The effect is to conceal what they’re doing," Klein tells the Journal.

The Scan

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