Dec 15, 2022 03:50pm; Fiercehealthcare.com
The owner of a genetic testing lab was convicted Dec. 14 in a scheme that involved calling Medicare recipients and telling them that they were covered for expensive tests. (Pixaby)
In a development in what’s being billed as one of the largest healthcare fraud schemes ever, a federal grand jury yesterday convicted the owner of a laboratory that performs sophisticated genetic tests of bilking Medicare out of hundreds of millions of dollars.
The crime involved telemarketers allegedly lying to Medicare recipients by ensuring them that they were covered for expensive genetic cancer tests, according to the Department of Justice (DOJ).
Telemedicine physicians allegedly approved the tests even though they hadn’t treated the patients and, in many cases, hadn’t even spoken to them. The DOJ said dozens of suspects might be involved in the scheme in which $463 million in questionable claims were made to Medicare.
The convicted individual—Minal Patel, 44, of Atlanta, the owner of LabSolutions LLC—personally pocketed $27 million of the $187 million that the scheme raked in from Medicare from July 2016 through August 2019.
Patient brokers, call centers and telemedicine companies also allegedly cashed in, as Patel paid them kickbacks and bribes after the Medicare beneficiaries agreed to take the tests, DOJ said. The patient brokers allegedly obtained signed doctors’ orders recommending the tests from telemedicine companies. Patel made the patient brokers sign contracts that misleadingly stated that the brokers were performing legitimate advertising services for LabSolutions.
A federal grand jury in Florida convicted Patel. The conviction includes one count of conspiracy to commit healthcare fraud, one count of conspiracy to defraud the U.S. and of paying and receiving illegal healthcare kickbacks, three counts of healthcare fraud and one count of conspiracy to commit money laundering. The hearing for his sentencing is scheduled for March 7. Patel faces a possible sentence of more than 140 years in prison.
The court did not agree with Patel that the cancer genetic testing he recommended should be given and paid for by Medicare because some of these tests are recommended by the U.S. Preventive Services Task Force (USPSTF) under certain conditions. The task force comprises experts who review evidence for the effectiveness of clinical preventive services and make recommendations about their use.
The court said, in response to Patel’s motion to dismiss the case, that even if it “were to accept Patel’s position that Medicare is required to cover USPSTF-recommended screening tests, the question of whether the CGx tests billed by Patel fell within this USPSTF recommendation—or were otherwise billed in a manner that Medicare covers—is a factual issue that cannot be resolved on a motion to dismiss.”
The court added: “As the Government correctly notes, this USPSTF recommendation does not endorse the conduct alleged in the Indictment— namely, ‘paying and receiving kickbacks in exchange for the referral of Medicare beneficiaries so that LabSolutions could bill Medicare for CGx tests, without regard to whether the beneficiaries needed the test’ and often where the doctor ordering the test did not interact with the beneficiary at all.”
The conviction results from an investigation by Operation Double Helix, part of the Health Care Fraud Strike Force. The operation focuses on cases of fraudulent genetic testing, and this particular case has led to dozens of charges being made against officials at cancer genetic testing labs and telemedicine companies for their alleged involvement.