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Genetic Testing Scheme Leads to Another Fraud Conviction

Posted  October 11, 2023

The DOJ recently announced another fraud conviction in connection with genetic testing. This conviction from a federal jury in Florida is the latest word in a string of fraud actions against companies and individuals offering to provide genetic testing services.

According to the DOJ, Jose Goyos and others managed the “‘doctor chase’ division” of a call center, which “contacted the primary care physicians of targeted Medicare beneficiaries and tricked these medical providers into ordering and authorizing medically unnecessary genetic tests based on medical paperwork that the call center created.” After securing the authorizations, Goyos and his co-conspirators would submit claims to Medicare for the unnecessary tests, the DOJ said. According to the DOJ, the labs “had no equipment, did not conduct a single test, and had no lab personnel”; instead, the tests were referred “to other labs, which conducted them at a small fraction of the price that Goyos and his co-conspirators charged to Medicare.” And after that, “the results often were not sent to the Medicare beneficiary’s primary care physicians and were not used in the treatment of the beneficiary,” per the DOJ’s press release.

The DOJ stated that this scheme resulted in submissions of “over $67 million” in false claims to Medicare and Medicare payments of “over $52 million.”

Claims of Medicare or Medicaid fraud for billing for unnecessary healthcare services is nothing new, but this illustrates the recent emphasis on going after providers of genetic testing services. The Department of Health and Human Services Office of Inspector General and law enforcement, for example, announced efforts to “target genetic testing fraud schemes nationwide.”

If you would like information on what it means to be a whistleblower or think you may have information relating to healthcare fraud, or laboratory and diagnostic testing fraud in particular, please feel free to contact us so we can connect you with a member of the Constantine Cannon whistleblower lawyer team for a free and confidential consultation.

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Tagged in: Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare, Provider Fraud,