Florida Doctor Charged Criminally in $2.1 Billion Medicare Fraud Scheme Involving Genetic Tests; Largest Medicare Fraud Scheme Ever

Thursday, October 31, 2019
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. According to prosecutors, the doctor allegedly authorized genetic testing for patients he never met, in a state where he’s not licensed to practice medicine.

The vast fraud scheme totaled $2.1 billion worth of false Medicare and Medicaid claims between July 2018 and January 2019.  This appears to be a new national record.  But please do not try to beat it!  The doctor is being charged in the United States District Court of New Jersey with conspiracy to commit health care fraud.


Fraudulent Orders for Genetic Testing.

Thirty-five defendants total are facing criminal charges for their alleged participation in one of the largest health care fraud schemes ever charged. All defendants involved were associated with telemedicine companies and cancer genetic testing laboratories, according to a Department of Justice (DOJ) news release. Click here to read the press release in full and learn more about the case and all the defendants being charged.

According to the release, the Florida doctor submitted fraudulent orders for genetic tests to numerous clinical laboratories.  He allegedly authorized his signature on patient documents to order tests for patients he had never met, treated or evaluated.  Additionally, according to an indictment filed by the District Court of New Jersey, he received about $5,000 a month for his role as Privy Health Lab’s medical director in Illinois.  During this period, he falsely reported himself as patients’ ordering physician so he could order genetic testing, when he had never seen or treated the patient.

In 2018 alone, Medicare paid clinical laboratories at least $4.6 million for genetic tests that this doctor allegedly ordered in this manner.

The Gainesville doctor faces charges of conspiracy to commit healthcare fraud following an investigation by the DOJ, U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG), and the Federal Bureau of Investigation (FBI).

We routinely advise our physician clients to avoid any sort of business arrangement offered to them which may produce a large amount of income with little or no work. Especially in the situation where the physician is asked to write orders or prescriptions, the physician must have an actual, established, legitimate doctor-patient relationship with the patient.  This includes actually eye-balling the patient.  This could not be the case if the patient is in another state where the doctor does not even have a license to practice medicine.  We have found that often older, semi-retired physicians or physicians who have discipline on their medical licenses are the ones approached by unscrupulous companies and businessmen who are seeking to take advantage of them.  They must ask if the deal looks too good to be true. They must also ask "Am I being asked to do something that may be illegal?" If so, run!  Or at least get an opinion form an experienced health lawyer about the deal.

To learn about a similar case of healthcare fraud dealing with genetic testing, click here and here to read my two-part blog series on a prior scam.


Contact Health Law Attorneys Experienced with Health Care Fraud and Qui Tam or Whistleblower Cases.

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

Attorneys with The Health Law Firm also represent health care professionals and others who may desire to file a qui tam, False Claims Act or whistleblower suit. We work with physicians, nurses and other professionals to investigate, document and file such cases. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding and other services that assist us in such matters. We have represented several doctors and other licensed health professionals as relators in bringing qui tam or whistleblower cases. Our attorneys are also available to defend physicians, medical groups and health care providers in qui tam or whistleblower cases.

To contact The Health Law Firm, please call (407) 331-6620 or visit our website at www.TheHealthLawFirm.com.


Sources:

Mavrakis, Emily. “Gainesville doctor charged for fraud over genetic testing.” The Gainesville Sun. (October 1, 2019). Web.

Villegas, Brianda. “Gainesville doctor charged in federal health care fraud case.” WCJB TV20. (October 1, 2019). Web.


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida area.  www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.


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10/31/2019

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