False ordering and billing of cancer genetic (CGx) tests has become a favorite target for federal fraud enforcers, with the U.S. Department of Justice (DOJ) reporting two notable convictions in the closing months of 2021.
On Nov. 17, a 57-year-old former lab sales rep from Pennsylvania became the fifth defendant to plead guilty in a bribery scheme generating over $340,000 worth of orders for CGx tests. The DOJ claimed that the rep solicited DNA samples from Medicare patients at health fairs and then sent the samples to a New Jersey lab for CDx testing in exchange for a commission. Having received his own bribe, the rep paid a kickback for use of a physician’s name and medical credentials to order the tests for Medicare patients.
On Dec. 21, the owner of a Kentucky marketing firm was convicted for her role in a similar kickback scheme accounting for nearly $235,000 in false billings of medically unnecessary CGx tests. As in the Pennsylvania scam, marketers collected samples at health fairs and paid physicians bribes for signed orders for CGx tests for patients the doctor never actually saw.
Each defendant faces a sentence of up to five years in prison and $250,000 in penalties, or twice the gross gain or loss derived from offense, whichever is higher, for violating the federal anti-kickback statute.
Get more insight on fraudulent billing of genetic tests in this recent National Lab Reporter article.