Search results for: genetic testing
OIG Alert: Beware of Genetic Testing Scam
The U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) recently sent out an alert about a fraud scheme involving genetic testing. The government watchdog agency said Medicare beneficiaries are being offered the chance to get tested for certain genetic conditions through the use of a simple cheek swab, but they…
Read MoreGovernment Cracking Down on Genetic Testing Labs
As the use of genetic testing has grown in popularity, so too have the number of investigations into allegations that these labs may be paying kickbacks to physicians for ordering unnecessary tests. Most recently, two testing labs, Proove Biosciences in Irvine, Calif. and Dallas-based Next Health LLC, have been under investigation for doing just that.…
Read MoreGenetic testing latest scam targeting Tricare
The Tricare program is once again the target of fraudulent claims. The health insurance program for members of the U.S. military, their family and retired military, has been bilked millions of dollars for unnecessary genetic tests and drug screening, according to media reports. The latest alleged Tricare scam goes something like this: Labs set up…
Read MoreMedicare Audit Finds Up To $888M in Improper Payments for Genetic Tests
Inadequate oversight by the Centers for Medicare & Medicaid Services (CMS) of payments for the highest paid genetic test risked up to $888 million in improper payments, according to a recent audit by the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG). OIG reviewed Medicare Part B claims for more…
Read MoreOIG Report: Genetic Tests Pose Risk for Fraud and Abuse
The use of genetic testing to determine the risk of developing certain diseases has taken off in recent years. And while they can help healthcare providers and their patients better understand the potential for future health problems and make informed decisions about their healthcare, their use also opens the door to fraud and abuse. A…
Read MoreCourt Reverses itself (in Part) in Laboratory Testing Case
A federal court judge in the District of Columbia has reversed his previous ruling that found Boston Heart Diagnostics Corp. was legally obligated to ensure the medical necessity of tests when submitting claims to Medicare. However, U.S. District Judge Reggie B. Walton did not go so far as to toss the lawsuit entirely, stating that…
Read MoreDoctor Charged in COVID-19 Healthcare Fraud Action Indicted in Kickback Scheme
A New York doctor has been charged in a superseding indictment in connection with an alleged genetic cancer screening and COVID-19 testing scam. Such an indictment adds information or evidence, as well as charges or defendants to an existing case. Alexander Baldonado of Queens was indicted on charges he engaged in a genetic testing and…
Read MoreFlorida Nurse Practitioner Guilty in Healthcare Fraud Scheme
A South Florida advanced registered nurse practitioner convicted for her role in a healthcare fraud scheme that billed Medicare more than $200 million in false and fraudulent claims, faces the possibility of decades behind bars. Thousands of Fraudulent Orders Signed Elizabeth Hernandez of Homestead was indicted in April 2022 on ten counts relating to her…
Read MorePennsylvania Lab Owner Sentenced to Prison in Illegal Kickback Scheme Involving Labs
The owner of two Pennsylvania testing labs in was sentenced to 18 months in prison, ordered to forfeit $9 million in criminal proceeds and pay more than $77 million in restitution for his involvement in an illegal kickback scheme. Ravitej Reddy pleaded guilty in 2020 to three conspiracy counts and one substantive count related to…
Read MoreTexas MD Faces Significant Prison Time for TRICARE Fraud
A Texas physician faces significant time behind bars after being convicted of engaging in a scheme to fraudulently bill TRICARE, for toxicology and genetic tests that were not provided as represented and/or were medically unnecessary. TRICARE is the healthcare program for uniformed service members, retirees, and their families, Dr. Sekhar Rao, a vascular and interventional…
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