A Georgia woman was arrested earlier this month in connection with a scheme in which she is alleged to have sought to pay and receive illegal kickbacks in exchange for referring Medicare beneficiaries for expensive cancer screening and COVID-19 tests.
Loosened healthcare regulations, including blanket waivers of the federal Anti-kickback Statute (AKS) and physician self-referral law (Stark) in response to the COVID-19 pandemic, could result in an onslaught of these types of healthcare fraud cases in the months to come.
According to the complaint, the defendant, identified as 32-year-old Ashley Hoobler Parris, aka Ashley Hoobler and Ashley Parris, started her scheme around October 2018 by soliciting kickbacks from labs in exchange for referring Medicare beneficiaries for expensive genetic cancer screening tests, regardless of medical necessity.
Hoobler and her co-conspirators would obtain doctors’ orders for CGX testing for those beneficiaries by paying illegal kickbacks to co-conspirators at telemedicine companies. She also received illegal kickbacks in exchange for sending the completed CGX swabs and doctors’ orders to a laboratory. The laboratory would then submit false and fraudulent claims to Medicare, according to the complaint.
CGX testing is a type of test that uses DNA sequencing to detect mutations in genes that could indicate a higher risk of developing certain types of cancers in the future.
Starting around February 2020, as the effects of the COVID-19 pandemic began to be felt, she allegedly agreed with others to be paid kickbacks on a per-test basis for COVID-19 tests, provided that those tests were bundled with more expensive Respiratory Pathogen Panel (RPP) tests. RPP detects certain respiratory viruses and bacterial pathogens, but cannot screen for COVID-19. Medicare’s reimbursement rates for the RPP tests are approximately four times higher than the reimbursement rates for the COVID-19 test.
Hoobler is owner of Encore Health Enrollment Inc., which purported to be a marketing company for genetic testing services. She received a percentage of the reimbursement that Medicare paid out for the tests.
Hoobler was heard on several recorded calls speaking with a government cooperator about how the scheme worked and how much money she would receive for each test, according to the complaint.
Since the COVID-19 epidemic, some lab owners and operators have been willing to pay illegal kickbacks in exchange for COVID-19 and RPP tests, according to the investigator on this case.
While there are compelling reasons in favor or relaxing existing healthcare regulations, history has shown us that fraudulent schemes often crop up when emergencies arise. Such fraud can end up costing the system millions of dollars. Preventing fraud is less costly than having to recover monies lost to it, as it takes time and money to catch and prosecute those engaged in fraud and not all of the monies taken is always recovered.
Our team of highly skilled attorneys and consultants are here to help you before you become the focus of an investigation, and will aggressively defend you should you become the target of one. Give us a call at 305-358-4500 or email firstname.lastname@example.org.