The Department of Justice (DOJ) charged 35 individuals with federal crimes arising from allegations involving fraudulent genetic cancer testing in September 2019. According to the charges, the defendants included medical professionals, telemedicine companies, and cancer genetic testing laboratories. The defendants lured elderly and disabled Medicare beneficiaries into ordering unnecessary or non-existent cancer genetic screening (CGx) laboratory tests and fraudulently billed Medicare over $2.1 billion dollars. Although these are the first charges involving genetic testing, it is unlikely to be the last as genetic testing is a rapidly growing area of the health care field.
Fraudulent genetic testing schemes will likely include but is not limited to the following:
- Paying/bribing physicians to prescribe expensive and unnecessary cancer genetic testing;
- Payments to marketers for referrals of patients on a commission basis;
- Upcoding and billing for more expensive tests than what was actually performed;
- Prescribing medically unnecessary genetic tests when physician did not treat or see patient;
- Illegal kickback payments to telemedicine companies to arrange/order medically unnecessary genetic testing for Medicare beneficiaries;
- Illegal kickback payments and bribes from CGx laboratories in exchange for referral of Medicare beneficiaries for expensive and unnecessary genetic testing; and
- Waiving expensive copays or other forms of renumerations to patients without justification or legitimate consideration of patient’s financial ability to pay.
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