DoJ Announces Charges In One of the Largest Health Care Fraud Schemes Ever

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 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 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.

“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.”

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.

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