Three telemarking company owners were charged for their alleged participation in a $46 million health care fraud, kickback, and money laundering scheme involving the referral of medically unnecessary cancer genetic tests to labs in exchange for kickbacks.
According to the indictment, the defendants allegedly participated in a scheme to operate a telemarketing campaign targeting Medicare beneficiaries in an effort to induce them to accept cancer genetic tests regardless of whether the tests were medically necessary or eligible for Medicare reimbursement. As part of the scheme, the defendants allegedly offered and paid illegal kickbacks and bribes to telemedicine companies in exchange for doctors' orders for expensive cancer genetic tests. The doctors' orders were written by doctors contracted with telemedicine companies, even though those telemedicine doctors had no prior relationship with the beneficiaries, were not treating the beneficiaries for cancer or symptoms of cancer, did not use the test results in the treatment of the beneficiaries, and did not conduct a proper telemedicine visit.
According to court documents, all three men sold these signed doctors' orders for cancer genetic tests to labs in exchange for illegal kickbacks. The indictment and information allege that the defendants caused one of the labs to submit approximately $46 million in claims to Medicare, of which over $27 million was paid. The indictment further alleges that the lab paid kickbacks totaling over $14 million, and that the defendants laundered these unlawful proceeds knowing that the transactions at issue had been designed to conceal and disguise the nature, source, and control of the proceeds.
The counts charging conspiracy to commit health care fraud and wire fraud count, conspiracy to commit money laundering, and substantive money laundering are each punishable by a maximum potential penalty of 20 years in prison. The counts charging health care fraud and anti-kickback violations are each punishable by a maximum potential penalty of 10 years in prison. Finally, the conspiracy to pay and receive kickbacks count is punishable by a maximum potential penalty of five years in prison. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.