A federal law enforcement action involving fraudulent genetic cancer testing has resulted in charges in five federal districts against 35 defendants associated with dozens of telemedicine companies and cancer genetic testing laboratories (CGx) for their alleged participation in one of the largest health care fraud schemes ever charged.
According to the charges, these defendants fraudulently billed Medicare more than $2.1 billion for these CGx tests. Among those charged are 10 medical professionals, including nine doctors.
No single organization was behind the fraud, and the operation dubbed “Double Helix” targeted defendants in Florida, Georgia, Louisiana, and Texas, the Justice Department said.
The alleged scheme was put into motion when a telemarketing or in-person “recruiter” would convince a Medicare enrollee to take a genetic test – assuring them that the full cost was covered by the program. Then, the patient would provide their Medicare information. Bills to Medicare connected with the scam mostly ranged from $7,000 to $12,000.
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. Often, the test results were not provided to the beneficiaries or were worthless to their actual doctors.
Some of the defendants allegedly controlled a telemarketing network that lured hundreds of thousands of elderly and/or disabled patients into a criminal scheme that affected victims nationwide. The defendants allegedly paid doctors to prescribe CGx testing, either without any patient interaction or with only a brief telephonic conversation with patients they had never met or seen.
The U.S. Department of Health and Human Services Office of Inspector General has previously issued a fraud alert for consumers in an effort to educate the public about such schemes.
The enforcement actions were led and coordinated by the Health Care Fraud Unit of the Criminal Division’s Fraud Section in conjunction with its Medicare Fraud Strike Force (MFSF), as well as the U.S. Attorney’s Offices for the Southern District of Florida, Middle District of Florida, Southern District of Georgia, Eastern District of Louisiana, and Middle District of Louisiana.
The MFSF is a partnership among the Criminal Division, U.S. Attorney’s Offices, the FBI, DEA and HHS-OIG.
In addition, the operation included the participation of various other federal, state and local law enforcement agencies, including the Louisiana Medicaid Fraud Control Unit.