Laboratory and genetic testing fraud are on the rise and on the Government’s radar. The Office of Inspector General recently issued a Fraud Alert, warning Medicare beneficiaries of a fraud scheme involving genetic testing. Genetic testing companies target Medicare beneficiaries and promise “free” genetic testing kits in exchange for the beneficiary’s Medicare insurance information. Medicare is then billed thousands of dollars for these tests, which were not ordered by the beneficiary’s physician and are not considered reasonable or medically necessary.
The Justice Department recently announced that a nationwide fraud enforcement operation, which targeted genetic testing scams, resulted in charges against 35 individuals who were responsible for over $1.7 billion in losses to Medicare. Among those charged include owners of telemedicine companies and laboratories, marketers, physicians, and nurse practitioners.
Genetic testing operations may violate the False Claims Act in various ways, including:
- Payment and receipt of kickbacks in exchange for referrals, in violation of the Anti-Kickback Statute;
- Billing for tests which are not reasonable or medically necessary;
- Fraudulent billing and coding practices, including “unbundling” components of a lab service and billing for each service separately; and
- Referrals to a lab in which the referring provider holds a financial interest, in violation of the Stark Statute.
Whether you are a patient or employee, if you believe you have discovered evidence of genetic testing or laboratory services fraud, contact our office for a free consultation regarding your whistleblower claims.