A Georgia woman is facing Federal charges related to allegations that she attempted to defraud Medicare by submitting false claims for cancer testing.
Prosecutors say the 32-year-old woman sought and received kickbacks from the owners and operators of a diagnostic testing facility, with the arrangement beginning in the fall of 2018 and continuing until her recent arrest. They say the arrangement was for her to submit cancer genetic (CGX) tests to the facility in exchange for cash payments in exchange for a percentage of the resulting reimbursement from Medicare. As the claims were submitted to Medicare as a result of illegal kickbacks, the claims themselves are fraudulent, leading to the charges in question.
In order to obtain test materials, the defendant and her co-conspirators arranged to have Medicare beneficiaries take the test in many cases where it was not medically necessary. To obtain orders for the testing, investigators say the defendant and her co-conspirators were in league with certain telemedicine firms that would order the unnecessary tests.
In addition to CGX testing fraud, investigators say the defendant took advantage of the global coronavirus pandemic as well. They say some diagnostic testing centers pay illegal kickbacks for the referral of COVID-19 testing kits due to their higher reimbursement from Medicaid. She also allegedly began receiving kickbacks for referrals of Respiratory Pathogen Panel tests as well, which reimburse an even higher amount from Medicare.
The defendant was charged last week in the court of U.S. Magistrate Judge Justin S. Anand of the Northern District of Georgia with conspiring to violate the Anti-Kickback Statute and conspiring to commit health care fraud. She was scheduled to have her initial court appearance later in the week.