Genetic testing fraud enforcement has dramatically increased in recent years, and that trend continues this week with yet another suit.

Recurring schemes in this space include billing Medicare for a test or screening that was
1. not medically necessary, 2. not ordered by the treating physician, and/or 3. tainted by a kickback. Medicare will cover genetic testing for certain conditions in some instances, but billers, like healthcare providers, genetic testing companies, and labs, must adhere to the government’s rules for coverage and billing. Limitations exist because genetic tests often cost hundreds or thousands of dollars each, which also means these pervasive scams cost taxpayers huge dollars.

A recently filed matter highlights the intersection between genetic testing fraud and telemedicine, another area of enforcement focus. The case targets a Delaware doctor who the government says referred more than 100 patients covered by Medicare for pricey genetic lab tests that were medically unnecessary. According to a press release, the referrals were based on short telemedicine visits or even no visits at all, and the doctor often did not examine the patients or use the test results to manage their care. The U.S. filed suit under the False Claims Act earlier this week.

Whistleblower Partners LLP represented a whistleblower in a successful genetic testing suit that recently settled. If you have concerns about fraud in this space, our attorneys have the expertise necessary to guide you. Contact us to learn more about your options.