On October 6, 2023, Defendant was convicted by a federal jury in Fort Pierce, Florida for his involvement in a $67 million Medicare fraud scheme. The Government charged that Defendant mislead physicians into authorizing numerous unnecesssary genetic tests that were not utilized in the subsequent medical care and treatment of patients.
The case revolved around a call center, managed by Defendant which was alleged to have engaged in telemarketing calls to Medicare beneficiaries and their physicians. A particular division of the call center, referred to as the “doctor chase” division, interacted with the primary care physicians of the targeted beneficiaries, aiming to secure their authorization for genetic tests based on created medical documentation.
During the trial, it was brought to light that there were allegations of misleading representations made to the medical providers, suggesting that the beneficiaries had requested these genetic tests and had medical conditions that warranted such testing. Upon obtaining the physicians’ authorizations, claims were then submitted to Medicare for these genetic tests.
The Government’s case suggested that the laboratories involved did not have the necessary infrastructure or personnel to conduct the tests and were alleged to have outsourced the genetic tests to other labs, which performed them at a lower cost. The disparity in the actual cost of testing and the amount claimed from Medicare was a key theme of the Government’s fraud case. According to the DOJ’s press release, the period between June 2020 and July 2021 saw claims of over $67 million submitted to Medicare, with over $52 million being paid out.
Defendant was ultimately convicted of conspiracy to commit wire fraud and conspiracy to commit money laundering. Defendant awaits sentencing and faces a maximum penalty of 20 years in prison for the conspiracy to commit wire fraud count and 10 years for the conspiracy to commit money laundering count.