The Department of Justice (DOJ) recently announced a multi-agency and multi-state coordinated law enforcement action against 35 individuals involved in an alleged $2.1 billion genetic cancer testing scheme. The alleged scheme involved the payment of illegal kickbacks and bribes to medical professionals in exchange for the referral of Medicare beneficiaries for expensive genetic testing. Doctors working for fraudulent telemedicine companies referred the beneficiaries for genetic testing services. The expensive genetic tests were often medically unnecessary, and the results were not provided to patients and useless to their actual doctors. The scheme reportedly targeted senior citizens and persons with disabilities, often using fears of cancer to induce older Americans to sign-up for the unnecessary tests.
The following individuals were charged as follows:
- Richard Garipoli of Loxahatchee Florida, the owner of the telemedicine company Lotus Health LLC was charged with conspiracy to commit health care fraud, conspiracy to pay and receive kickbacks, health care fraud, and receiving kickbacks. The indictment alleges that Garipoli and co-conspirators billed Medicare and Medicare Advantage plans more than $326 million for fraudulent Cancer Genomic tests (CGx Tests) that were not medically necessary or eligible for reimbursement. The scheme allegedly included doctors that contracted with Lotus Health and authorized false doctors’ orders for the tests in exchange for kickbacks.
- Jamie Simmons of South Carolina, owner of telemedicine companies MedSymphony LLC and Metmydocc LLC was also charged with conspiracy to commit health care fraud, conspiracy to pay and receive kickbacks, health care fraud, and receiving kickbacks. Simmons allegedly conducted a scheme similar to Garipoli, including contracting with doctors that could authorize bogus orders for CGx Tests in exchange for kickbacks.
- Minal Patel of Atlanta, Georgia was charged with his role in the scheme, where he allegedly solicited unnecessary GCx tests from Medicare beneficiaries at “health fairs” and through telemarketing. Telemedicine physicians approved the tests for patients they allegedly never spoke to or treated. Patel then paid telemarketers illegal kickbacks and bribes in exchange for doctor’s orders and medically unnecessary tests, which he used to bill Medicare for more than $494 million.
- Khalid Satary of Suwanee, Georgia was also charged for running a scheme similar to Patel. He would solicit tests from Medicare beneficiaries through telemarketing and “health fairs” and then have doctors approve the order without ever seeing the patient. The scheme resulted in Satary billing more than $547 million to Medicare for unnecessary CGx tests.
- Anthony T. Securo of Columbus, Georgia was indicted for allegedly signing thousands of durable medical equipment (DME) orders for beneficiaries who he never met and only spoke to briefly over the phone. The thousands of DME items were billed to Medicare for over $23 million. Additionally, 18 other individuals, including doctors, physician recruiters, and nurse practitioners from Georgia have been charged for billing Medicare for medically unnecessary DME, genetic testing, and pain cream.
- Sekhar Rao and Vinay Paramesware of Austin, Texas were charged for their role in a scheme that involved the individuals ordering unnecessary genetic and toxicology tests for TRICARE beneficiaries. Rao and Paramesware signed testing orders for individuals they had no provider-patient relationship with and often repeated the tests multiple times. The test results were never provided to the individuals. Rao, Paramesware, and others caused over $36 million in false claim submissions to TRICARE.
- The Northern District of New Jersey also announced charges against several individuals including operators of Ark Laboratory Network, LLC, Privy Health Inc, and another company that acquired DNA samples and Medicare information from hundreds of patients. The information was acquired through various means, including the provision of $75 gift cards to beneficiaries. The physicians involved had no patient-provider relationship with the individuals, and the orders were authorized by a physician who was not licensed to practice in the state where the patients were located. Some of the individuals charged were also allegedly involved in kickback arrangements with the testing labs and the kickback amounts were based on the percentage of Medicare revenue that the labs received in connection with the tests. The individuals allegedly issued fraudulent invoices to cover up the kickbacks.
Additional defendants from Texas, Florida, and Louisiana have been charged, all for their role in schemes related to unnecessary GCx testing for patients that were never treated by the ordering physicians and then billing for such services to Medicare.
The DOJ Health Care Fraud Unit of the Criminal Division’s Fraud Section, the Medicare Fraud Strike Forces, and the U.S. Attorney’s Offices for various districts led and coordinated the cases. The Centers for Medicare & Medicaid Services (CMS) Center for Program Integrity also announced that it took administrative action against the CGx testing companies.
The DOJ Press Release is available at: