Atlanta Medical Group Execs Jailed for $8.5 Million Allergy Testing Scheme

Case: The two owners of now defunct Primera Medical Group pled guilty to criminal charges for their role in billing insurers for allergy blood tests that weren’t medically necessary, ordered by a physician or, in many cases, even performed. Details: Primera hired market research firms to pay fees to recruit privately insured patients to undergo allergy testing regardless of whether they had symptoms indicating the tests were medically necessary, generating over 4,500 claims seeking $8.5+ million from private insurers. The owners even fabricated false lab reports for tests that were never completed and sent them to not only insurers but also directly to patients, in one case sending phony results to the family of a 5-year-old girl suffering from an unknown reaction. Both owners were fined over $1.5 million and sentenced to 81 months and 93 months in jail, respectively, followed by three years of supervised release. Significance: In addition to health fraud, the owners committed aggravated identity theft by billing insurers for the tests and allergy immunotherapy injections administered to nearly every patient using National Provider Identifiers of other doctors without their knowledge.