Each week, the Allegiant Experts Blog takes a look at a case of interest in the world of health care fraud and medical misconduct. Many of the stories we write about showcase interesting or unique spins that people in the medical profession use to attempt to defraud our nation’s health insurance programs. This week, we have a particularly interesting story to report on.

Last week, the United States Department of Justice announced that charges had been laid against 35 different individuals in one of the largest health care fraud schemes ever. According to the report, a federal law enforcement action involving fraudulent genetic testing was responsible for over $2.1 billion in losses. The scheme involved luring elderly patients from all over the country into fraudulent genetic cancer tests.

The charges that were laid against the 35 individuals spanned across five federal districts.

The defendants are associated with dozens of telemedicine companies and cancer genetic testing laboratories (CGx). Allegedly, they each fraudulently billed Medicare more than $2.1 billion for these CGx tests. Among those charged are ten medical professionals, including nine doctors.

In addition, the DoJ announced that the Centers for Medicare & Medicaid Services, Center for Program Integrity (CMS/CPI) took adverse administrative action against cancer genetic testing companies and medical professionals who submitted more than $1.7 billion in claims to the Medicare program.

According to the DoJ report, “the coordinated federal investigation targeted an alleged scheme involving the payment of illegal kickbacks and bribes by CGx laboratories in exchange for the referral of Medicare beneficiaries by medical professionals working with fraudulent telemedicine companies for expensive cancer genetic tests that were medically unnecessary.”

In many cases, the test results weren’t even given to the beneficiaries.

In other cases, the results were worthless to their actual doctors. Some of the individuals who have been charged allegedly controlled a telemarketing network that lured hundreds of thousands of elderly and/or disabled patients into a criminal scheme.

To lure their patients, the fraudsters paid physicians to prescribe CGx testing. The prescriptions were made either without any patient interaction or with only brief telephone conversations with patients they had never even met.

Ariana Fajardo Orshan is the U.S. Attorney of the Southern District of Florida.  

“The defendants are alleged to have capitalized on the fears of elderly Americans in order to induce them to sign up for unnecessary or non-existent cancer screening tests,” she is quoted as saying in the DoJ report, “The genetic testing fraud schemes put personal greed above the preservation of the American health care system.  The U.S. Attorney’s Office in South Florida, alongside our law enforcement and USAO partners, remains committed to protecting taxpayer dollars and the Medicare program from abuse.”

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

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