Medicare Fraud Scam Cheek Swabs

In this photo provided by the Department of Health and Human Services Office of the Inspector General, federal agents from the HHS Office of Inspector General prepare for operations targeting individuals allegedly involved in genetic testing fraud in the Atlanta region, Friday morning, Sept. 27, 2019. Federal law enforcement officials say they’ve taken down a Medicare fraud scheme that enticed seniors to get their cheeks swabbed for unneeded DNA tests.

Seven Floridians including four doctors are among 35 people arrested Friday by the FBI for alleged involvement in a $2.1 billion fraud that charged Medicare for false cancer genomic tests (CGx tests).

According to the U.S. Department of Justice (DOJ), the alleged fraud was perpetrated by defendants in Florida, Georgia, Louisiana and Texas and exploited seniors' curiosity about genetic medicine by enticing them to get unneeded DNA tests.

Dubbed "Operation Double Helix," the crackdown targeted telemedicine companies, nine doctors and numerous labs following a joint investigation by the DOJ, the FBI, the U.S. Health & Human Services (HHS) Inspector’s General Office and U.S. attorneys' offices.

The DOJ said the alleged scheme involved a telemarketer or in-person "recruiter" who would persuade a Medicare enrollee to take a genetic test, assuring them the program would pay full cost.

A doctor “in league with the fraudsters” would then approve the test and collect a kickback from the “recruiter,” the indictment reads.

A lab would run the test, bill Medicare, and share payments with the “recruiter,” according to the DOJ.

HHS Assistant Inspector General Shimon Richmond said genetic testing bills submitted to Medicaid ranged from $7,000 to $12,000, with some as high as $33,000. In many cases, he said, the patient never got a report back, or the results provided were incomprehensible.

"A decade ago, it would have given Medicare beneficiaries pause if someone wanted to get a swab from their cheek of their saliva," he said in a statement accompanying the indictments. "Today people know and recognize what (genetic testing) is, and they think 'I can get that done, and I can get it done for free and find out if I have health issues that I need to address.'"

U.S. attorney’s offices in the Southern and Middle districts of Florida filed charges against defendants while four Florida doctors were indicted by U.S. attorneys in New Jersey. They are:

• Richard Garipoli, 42, of Loxahatchee, owner of a telemedicine company Lotus Health LLC, is charged in the Southern District of Florida with conspiracy to commit health care fraud, conspiracy to pay and receive kickbacks, and substantive counts of health care fraud and receiving kickbacks.

According to the indictment, Garipoli “and unnamed co-conspirators” billed Medicare and Medicare Advantage plans more than $326 million, for which Medicare paid over $84 million, for “false and fraudulent” CGx tests between January 2017 and September 2019.

Clio Laboratories in Lawrenceville, Ga. and LabSolutions in Atlanta and Easton, Pa., then submitted false and fraudulent claims to Medicare and Medicare Advantage plans for the CGx tests, the DOJ alleges.

• Jamie Simmons, 62, who owns Fort Lauderdale-based telemedicine companies MedSymphony LLC and Meetmydocc LLC, is charged with conspiracy to commit health care fraud, conspiracy to pay and receive kickbacks, and substantive counts of health care fraud and receiving kickbacks.

According to the DOJ, Simmons and “unnamed co-conspirators” billed Medicare and Medicare Advantage plans more than $56 million, for which Medicare paid over $17 million, between January 2018 and September 2019.

• Ivan Andre Scott, 34, of Kissimmee, a “marketer,” was charged In the Middle District of Florida for his role in an alleged $2.8 million scheme to provide Medicare beneficiary information to doctors and telemedicine companies.

• Four Florida doctors – Matthew Ellis, 53, of Gainesville; Edward Kostishion, 59, of Lakeland; Kacey Plaisance, 38, of Altamonte Springs; Jeffrey Tamulski, 46, of Tampa – were charge in the U.S. District of New Jersey on an array of charges.

According to the DOJ indictment, Kostishion, Plaisance, and Dr. Jeremy Richey, 39, of Mars, Pa., operated Ark Laboratory Network LLC, “a company that purported to operate a network of laboratories that facilitated genetic testing.”

Ark partnered with Privy Health, Inc., operated by Dr. Kyle Mclean, 36, of Arlington Heights, Ill., and another company to acquire DNA samples and Medicare information from hundreds of patients through various methods, including offering $75 gift cards to patients, all without the involvement of a treating health care professional, the indictment reads.

Ellis served as the ordering physician who authorized genetic testing for hundreds of patients across the country “that he never saw, examined, or treated. These included patients from New Jersey and various other states where Ellis was not licensed to practice medicine,” according to the DOJ.

“In 2018 alone, Medicare paid clinical laboratories at least approximately $4.6 million for genetic tests that Ellis ordered in this manner,” the DOJ states.

The DOJ maintains Kostishion, Plaisance, Richey and Tamulski concealed kickbacks by “issuing sham invoices to laboratories that purportedly reflected services provided at an hourly rate even though the parties had already agreed upon the bribe amount, which was based on the revenue the laboratories received.”

In 2018, the indictment alleges, the clinical laboratories paid Ark “at least approximately $1.8 million in bribes.”