A physician was recently convicted for his role in a healthcare fraud conspiracy involving cancer genetic tests telemedicine companies, marketing companies and a lab. The physician was convicted of conspiracy to violate the Federal Anti-Kickback Statute by causing more than $9.5 million of fraudulent claims to be submitted to Medicare and Medicaid. The fraudulent scheme involved a web of kickbacks and other fraudulent activity between the co-conspirators. The physician ordered thousands of tests without meeting the patients in person or via telemedicine and in exchange was paid kickbacks by telemedicine companies. Those companies were paid kickbacks by marketing companies that targeted federal beneficiaries at health fairs, nursing homes, and through door-to-door marketing. The swab kits were sent to a lab in Tennessee for processing and the lab paid kickbacks to the marketing companies.
The OIG published a fraud alert on this topic in 2019 before the pandemic (see alert here Fraud Alert: Genetic Testing Scam | Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services (hhs.gov)) and the government has not wavered in its investigation and enforcement of these fraudulent schemes. Providers involved in all aspects of genetic testing (ordering, marketing and testing) should be cognizant of the strict requirements surrounding this issue.