Genetic Testing Kickback Scheme Settled

Jacksonville, Fla.-based Ocenture LLC and its subsidiary, Carelumina LLC, agreed to pay $3 million to settle allegations that they paid and received kickbacks in connection with genetic testing samples.

It was alleged that Ocenture solicited genetic testing samples from Medicare beneficiaries directly and through other marketers. The company then paid physicians to falsely attest that the genetic testing was medically necessary and arranged for the laboratories to process the tests and receive reimbursement from Medicare, with a portion of that reimbursement being paid to Ocenture. 

The resolution was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Office for the Middle District of Florida, with assistance from the HHS-OIG and the FBI.

The initial case was filed under the qui tam or whistleblower provisions of the False Claims Act by Christopher Improta and Peter Brandt, two marketers who were approached by Ocenture to participate in the alleged kickback scheme. As a result, they will receive approximately $570,000.

Under the whistleblower provision private individuals who assist a prosecution can receive all or part of the damages or financial penalties recovered by the government resulting from the prosecution.

In fiscal year 2022, the Security and Exchange Commission received more than 12,300 whistleblower tips, which resulted in 103 awards to whistleblowers totaling $229 million. The number of whistleblower tips received was approximately 100 more compared to fiscal year 2021.

In January, we wrote about a Data Brief released by the U.S. Department of Health and Human Services Office of Inspector General which found that between 2016 and 2019, Medicare payments for genetic tests quadrupled from $351 million to $1.41 billion, an increase of 302 percent.

As far back as 2019, the U.S. Department of Health and Human Services Office of the Inspector General announced efforts to target genetic testing fraud schemes nationwide. And as far back as 2017, our firm was writing about these schemes.

As the use of genetic testing continues to increase, so too does the opportunity for fraud and abuse. OIG has made it clear that it will continue to monitor this area of concern and providers would be well advised to make sure their testing practices are in compliance.

The Health Law Offices of Anthony C. Vitale can provide you with compliance oversight services, assuring that your business relationships are compliant with all federal and state fraud, waste and abuse laws. Give us a call at 305-358-4500, or send an email to info@vitalehealthlaw.com and let’s discuss how we might be able to assist you.