At the beginning of April, we blogged about a coronavirus-related fraud scheme perpetuated by 49 year-old Georgia man, Erik Santos. The story demonstrated to us just how low some people can go. After all, the pandemic is already hard enough on us all. Scam artists who have utilized the current crisis for their greedy desires have sunk to all new lows in the world of health care fraud.

32 year-old, Ashley Hoobler Parris has joined the ranks of those low sinkers.

Also from Georgia, the woman who also goes by Ashley Hoobler and Ashley Parris was arrested last week for her alleged role in a conspiracy to defraud Medicare. According to the Middle District of Florida branch of the United States Department of Justice, Hoobler submitted false claims for both cancer genetic (CGX) testing and COVID-19 testing.

The complaint against Hoobler alleges that she solicited and received illegal kickback payments from the owners and operators of a diagnostic testing laboratory in exchange for referring Medicare beneficiaries to them. Those individuals, however, were not eligible for reimbursement. The scheme is alleged to have begun in October of 2018.

The laboratory paid Hoobler a percentage of the paid claims as kickbacks.

“CGX testing is a type of test that uses DNA sequencing to detect mutations in genes that could indicate a higher risk of developing certain types of cancers in the future,” explains the DoJ, “Medicare rules and regulations provide that CGX testing is only reimbursable under certain specific circumstances, and tests not ordered by the physician who is treating the Medicare beneficiary are not considered reasonable and necessary.”

The report goes to explain that Hoobler and her co-conspirators obtained Medicare patient information and swabs by having Medicare beneficiaries complete genetic test kits. These tests were conducted even though they weren’t medically necessary. The group would then obtain doctors’ orders for CGX testing for those beneficiaries by paying illegal kickbacks to co-conspirators at telemedicine companies.

The start of the COVID-19 pandemic took things to another level.

Beginning in February of this year, Hoobler agreed to be paid kickbacks on a per-test basis for COVID-19 tests as long those tests were bundled with RPP tests. This was done because Medicare’s reimbursement rates for RPP tests are about four times higher than the reimbursement rates for COVID-19 tests.

Maria Chapa Lopez is the U.S. Attorney of the Middle District of Florida. “Fraud related to COVID-19 is particularly disturbing as it exploits a national crisis for personal gain,” she is quoted as saying, “The U.S. Attorney’s Office and our law enforcement partners remain focused on investigating and prosecuting individuals seeking to defraud federal government programs for personal profit,  especially during this pandemic.”

Are you an attorney who is currently trying a health care fraud case?

Contact Allegiant Experts to find out how our clinical expertise may help your case. Our experts have been providing expert clinical services for two decades and can help your team by bridging the disciplines of medicine, coding and billing to ensure accurate payment and data is achieved. Please don’t hesitate to give us a call at 407-217-5831 or email us at info@allegiantexperts.com.