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uBiome Routinely Billing Patients Multiple Times Without Their Consent

According to an article published on CNBC’s website, on Friday, April 26, 2019, the FBI raided the San Francisco office of health start-up uBiome after it came under scrutiny for its billing practices regarding tests for the microbiome – the microorganisms that live in the digestive tract and other parts of the body.  The company sells health tests called SmartGut and SmartJane for people who want to monitor their gut health and then bills insurers after physicians prescribe the products. It is unclear, however whether microbiome testing should be paid for by interested consumers or used as a clinical tool for doctors treating patients that is covered by health insurance.  CNBC reported that uBiome routinely charged patients’ plans twice for tests using the same sample.  That includes Medicare patients, whose insurance is provided by the government. Companies that bill Medicare for tests that are not deemed medically necessary may violate federal rules.  It was also revealed that uBiome pressured its physicians to approve tests with minimal oversight.

In addition to the FBI, the California Department of Insurance and multiple insurers, including Anthem Inc., Aetna Inc. and Cambia Health Solution’s Regence Blue Cross Blue Shield unit, are examining uBiome’s billing practices.  On May 1, 2019, uBiome said that its co-CEOs and founders Jessica Richman and Zac Apte are on “administrative leave” and that the board would launch an independent investigation into uBiome’s billing practices. John Rakow, the company’s general counsel, has taken on the role of interim CEO.

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