Telemedicine Fraud Conspirators Billed for Faulty Genomic Testing
Medicare and Medicaid reimbursed labs millions of dollars for genomic testing that was produced through a series of kickback payments in a recent telemedicine fraud scheme.
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- The owner of a telemedicine company has pleaded guilty to conspiracy to pay and receive kickback payments, which led to Medicare and Medicaid programs losing millions of dollars through fraudulent reimbursements for cancer genomic testing.
Elizabeth Turner, age 34, of Glenview, Kentucky was the owner of the telemedicine company Advanced Tele-Genetic Counseling (ATGC). She was charged by criminal information in November for conspiring to defraud Medicare and Medicaid programs and to offer, pay, solicit, and receive kickbacks.
Her co-conspirators included Fadel Alshalabi, owner of Crestar Labs LLC in Spring Hill, Tennessee, Melissa Lynn Chastain, owner of marketing company Genetix LLC in Belton, South Carolina, and other involved marketers and physicians.
Turner’s telemedicine company received kickback payments from marketers between February 2018 and August 2019 for providing signed doctors’ orders for cancer genomic testing. Cancer genomic testing can help detect mutations in genes that may indicate a higher risk of developing cancer in the future, but it cannot diagnose the presence of cancer in an individual.
Turner obtained the signed doctors’ orders by paying kickbacks to physicians. Turner was aware that the physicians were not treating the patients for any medical conditions and usually did not have any contact with the patients, according to a Department of Justice news release. She also knew that the tests were not medically necessary and the physicians were not using the results to benefit the patients.
The involved marketers went door-to-door at nursing homes and senior citizen fairs, convincing Medicare and Medicaid patients to provide their genetic material by using a mouth swab kit. Crestar Labs paid the marketers kickbacks in exchange for the swab kits, which they used for cancer genomic testing, the news release stated. Crestar Labs then billed Medicare and Medicaid for the genomic tests.
Medicare and Medicaid ended up reimbursing the laboratories millions of dollars that were considered fraudulent because the tests were obtained through kickback payments, rendering them ineligible for reimbursement.
Additionally, Turner’s telemedicine company received around $234,730 in illegal kickback payments from the marketing companies, including Genetix.
She will receive her sentencing on May 2, 2022, and could face up to five years in prison, a fine of up to $250,000, restitution to Medicare and Medicaid, and forfeiture of the money she illegally obtained.
The Office of the Inspector General (OIG) and the Federal Bureau of Investigation (FBI) investigated the case and assistant U.S. attorneys Sarah K. Bogni and Robert S. Levine are prosecuting it.
A recent telemedicine fraud case centered around genetic testing and kickback payments as well. In September, a Florida man pleaded guilty to a kickback conspiracy in which telehealth providers authorized expensive and medically unnecessary cancer and cardiovascular tests in exchange for access to Medicare beneficiaries whom they could bill for virtual visits.
Additionally, four individuals were recently charged for their involvement in a telemedicine fraud scheme that used kickback payments as a means to generate faulty prescriptions for medications and durable medical equipment.
Recent legislation seeks to address and prevent telehealth fraud with provisions that call for in-person visits prior to durable medical equipment distribution and heightened monitoring from the Centers for Medicare and Medicaid Services (CMS) to identify fraudulent behavior among providers.
