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Fraud and Abuse Update: 12/2/2019 (AHLA)
In September, the Department of Justice announced charges against nearly three dozen individuals across five federal districts, including the Southern District of Georgia, for their alleged roles in defrauding Medicare for expensive cancer genetic testing that was medically unnecessary. The individuals worked for telemedicine companies and genetic testing labs.
The latest charges allege Siado and his company, along with other unindicted co-conspirators, paid individuals to solicit information and DNA swabs from low-income elderly residents, a press release said.
Defendants allegedly paid the individuals $150 for each “patient” whose information was obtained and transmitted to another unindicted co-conspirator company that would fraudulently bill Medicare and Medicaid. Prosecutors alleged Siado and his company received a kickback of $100 to $575 per test accepted for billing, the release said.
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Fraud and Compliance Update
Nearly three dozen individuals across five federal districts are facing charges for their alleged roles in defrauding Medicare of more than $2.1 billion for expensive cancer genetic testing that was medically unnecessary, the Department of Justice (DOJ) announced September 27.
The 35 individuals are associated with dozens of telemedicine companies and genetic testing laboratories and include ten medical professionals, DOJ said in a press release.
A coordinated federal investigation of DOJ’s Criminal Division, the Department of Health and Human Services Office of Inspector General, and the Federal Bureau of Investigation targeted the alleged scheme, which involved laboratories paying illegal kickbacks and bribes to medical professionals working with fraudulent telemedicine companies in exchange for referrals of Medicare beneficiaries for the costly cancer genetic tests, prosecutors said.
Defendants allegedly paid doctors to prescribe the testing without any patient interaction or only a brief conversation over the phone. The test results often were not provided or were worthless, DOJ alleged.
Certain defendants, including CEOs and CFOs, allegedly controlled a telemarketing network that targeted elderly or disabled patients, convincing them to sign up for the unnecessary genetic tests.
“The scope and sophistication of the health care fraud detected in Operation Double Helix and the related Operation Brace Yourself is nearly unprecedented,” said U.S. Attorney for the Southern District of Georgia Bobby L. Christine.
Meanwhile, the Centers for Medicare & Medicaid Services (CMS) Center for Program Integrity announced administrative action against cancer genetic testing companies and medical professionals who submitted more than $1.7 billion in Medicare claims.
“CMS continues to use a comprehensive and aggressive program integrity approach that includes fraud prevention, claims review, beneficiary education, and targeting high-risk areas of the federal healthcare programs with new tools and innovative demonstrations,” said CMS Administrator Seema Verma.
The charges were brought in federal districts in Florida, Louisiana, Georgia, and Texas.
For example, in the Southern District of Florida, Richard Garipoli, who owned Lotus Health LLC, a telemedicine company, was charged with billing Medicare more than $326 million for medically unnecessary cancer genomic tests. Medicare paid more than $84 million of those claims.
Nineteen individuals were charged in the Southern District of Georgia, including two “telemedicine” physician recruiters, seven physicians, two nurse practitioners, two individuals who brokered the sale of physician orders, one company that brokered the sale of physician orders, and four durable medical equipment companies. Defendants allegedly were responsible for more than $400 million in genetic testing, durable medical equipment, and pain cream billing to Medicare, prosecutors said.
10/4/2019 (AHLA)U.S. Attorney for the Middle District of Florida Maria Chapa Lopez announced charges against seven individuals for their alleged involvement in schemes to defraud Medicare, Medicaid, and other federal health care benefit programs, and in conspiracies to illicitly obtain and distribute oxycodone and other controlled substances.
According to a press release, Marcus Anderson was charged in a 13-count indictment with health care fraud and aggravated identity theft for stealing providers’ identities to submit more than $1.2 million in false and fraudulent claims to Medicaid.
Teresa Johnson, who owned and operated Tri-County Medical Billing, was charged with conspiracy to commit health care fraud for allegedly submitting fraudulent claims to Medicare, Medicaid, Tricare, and ChampVA, on behalf of a medical doctor who owned several clinics in Florida.
In addition, Hong Truong, Jessica Evans, Lucretia Mullan, Robin Lloyd, and Patrice Jackson were charged in separate indictments with conspiracy to unlawfully distribute and dispense Schedule II controlled substances, among other charges.
Charges contained in the indictments are allegations only; all defendants are presumed innocent until proven guilty in court.