According to the Department of Justice (DOJ) genetic testing is the next frontier for healthcare fraud.
In a fraudulent operation that the Department of Justice calls, “unprecedented”, elderly or disabled patients nationwide were lured into providing their DNA for testing in a widespread genetic testing fraud scheme powered by a large telemarketing network. The doctors involved were paid to write orders prescribing the testing without any patient interaction or with only a brief telephone conversation.
There were dozens of arrests in numerous states against defendants who were associated with telemedicine companies and cancer genetic testing laboratories. The allegations involve payment of illegal kickbacks and brides by laboratories in exchange for the referral of Medicare beneficiaries by medical professional working with fraudulent telemedicine companies. These cancer genetic tests are expensive and were medically unnecessary. Routinely the test results were not provided to the beneficiary or the results were of no value.
Recently, physicians and other medical professions in Georgia were charged with allegations of a fraudulent scheme involving trafficking orders and prescriptions for genetic tests. Operation Double Helix was focused on fraudulent billing of genetic testing using Medicare and Medicaid dollars. These individuals allegedly duped Medicare beneficiaries into signing up for unnecessary genetic tests. This model was also the subject of numerous arrests for the sale of braces and other durable medical equipment in an effort dubbed, Operation Brace Yourself.
Both scams involved marketing that lured elderly Medicare beneficiaries to marketing hotlines that then used telemedicine to secure physician orders for testing in order to supply braces and other durable medical equipment which were medically unnecessary.