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  4.  → What happens if a lab is caught in the middle of a healthcare fraud scheme?

What happens if a lab is caught in the middle of a healthcare fraud scheme?

The federal government recently accused a group of over three dozen healthcare professionals from throughout the country of working together to defraud the government. The prosecution claims the accused conspired to falsely charge the government for medically unnecessary genetic tests. The scheme allegedly involved physicians who would order these genetic tests from one of two labs located in Texas.

Allegations include:

  • Illegal remuneration. The government claims those involved would offer up referrals in exchange for ordering these tests. These referrals included telemedicine visits. The provider would then bill Medicare for the visit.
  • False claims. The prosecution further claims that although the provider would bill for the telemedicine visits noted above, they often never followed through. They claim the physicians billed the government for appointments that never happened.

These claims have led to felony criminal charges.

The allegations also extend to include medical professionals from Florida, Alabama, Mississippi, Missouri, California, Tennessee, New York, Pennsylvania, Michigan, Louisiana, and North Carolina.

Was the lab an active participant in the allegedly fraudulent practices?

When it comes to any participant, including those who were part of the lab, the first question the government will try to determine is likely whether or not those involved were active participants. Did they follow the applicable rules and regulations or not?

In this case, the owners of the lab admitted to conspiring with others to arrange telemedicine providers to authorize the genetic testing at their labs.

What penalties are possible in these types of cases?

The accused face felony criminal charges which can result in steep financial penalties as well as potential imprisonment. The case is complex, some of the accused have already moved forward through sentencing and others are still going through the process, the exact punishment is not yet known. The Texas lab owner plead guilty to conspiracy to offer kickbacks and paying a kickback. The court sentenced the lab owner to 82 months imprisonment.

Criminal penalties are only one consequence of these allegations. Consequences from local state boards are also likely. One physician recently reported that he was forced to give up his medical license to practice medicine and agree to never apply to practice again in the state as a result of these charges.

What should lab owners learn from this case?

First, that these cases are complex. The investigation and efforts of the prosecution have been moving forward for years and many layers of the case are not yet resolved. It is important to prepare for a long haul when facing these types of allegations. Take the time to build a defense and put a team together that can help protect your interests.

The case also highlights the importance of regular internal audits. This practice can help to better ensure the lab is operated in accordance with applicable rules and regulations and mitigate the risk of these types of allegations.

Attorney John Rivas is responsible for this communication