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.
The vast fraud scheme totaled $2.1 billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. The physician is being charged in the United States District Court of New Jersey with conspiracy to commit health care fraud.
Alleged Fraudulent Orders for Genetic Testing.
Thirty-five separate defendants are now facing felony charges for their alleged participation in one of the largest health care fraud schemes ever investigated and charged. All defendants involved were somehow associated with telemedicine companies and cancer genetic testing laboratories, according to a Department of Justice (DOJ) news release. Click here to read the DOJ press release in full and learn more about the case and all the defendants being charged.
According to the release, one of the defendants, 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, seen, treated or evaluated. Additionally, according to an indictment filed by the District Court of New Jersey, this physician received about $5,000 a month for his role as Privy Health Lab’s medical director in Illinois. During this period, according to prosecutors, he falsely reported himself as the patients’ ordering physician so that he could sign orders for the genetic testing. In 2018 alone, Medicare paid clinical laboratories at least $4.6 million for genetic tests that he 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).
To learn about a similar case of healthcare fraud dealing with genetic testing, click here to read part one and here to read part two of my blog series on a prior scam.
Innocent until Proven Guilty in a Court of Law.
We are writing this blog from information from several different media sources including those referenced below and a DOJ press release. It must be remembered that just as is consistently stated in the “Bad Boys” television series, “the defendants are presumed innocent until proven guilty in a court of law.”
Contact Health Law Attorneys Experienced with Health Care Fraud and Qui Tam or Whistleblower Cases.
The Health Law Firm’s attorneys routinely represent physicians, medical practices, clinical labs, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (ALfs), 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.
U.S. Department of Justice, Press Release dated September 26, 2019, (https://www.justice.gov/usao-nj/pr/federal-health-care-fraud-takedown-northeastern-us-results-54-defendants-charged-and)
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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