The Department of Justice recently announced a $2.1 billion settlement for a federal whistleblower lawsuit regarding allegedly fraudulent claims for genetic testing.

According to the Sept. 27 announcement, 35 defendants have agreed to pay a combined $2.1 billion to resolve claims related to allegedly fraudulent CGx cancer genetic testing as part of the “one of the largest healthcare fraud schemes ever charged,” according to NPR.

The settlement was released in connection with a large coordinate law enforcement effort from the Department of Justice Criminal Division’s Health Care Fraud Unit, the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG), Federal Bureau of Investigation (FBI), and several state authorities.

Due to the results of “Operation Double Helix,” these authorities charged over 380 defendants with defrauding medical care programs for over $3 billion.

The fraud reportedly involved many layers of medical professionals, including nine doctors who would exchange and sell patient information leading to fraudulent prescription claims with government healthcare programs. The scheme allegedly involved further fraud in the form of illegal kickbacks, bribes, and fraudulent telemarketers.

First, fraudulent telemarketers would allegedly troll Medicare beneficiaries online, over the phone, or face-to-face at health fairs, religious institutes, low income housing, senior centers, and more.

These people were allegedly offered genetic testing which would estimate their cancer risk and examine the efficacy of certain drugs. In order to receive this testing, consumers reportedly had to provide their Medicare info, driver’s license, and a DNA sample from their cheek.

The alleged scheme reportedly preyed on the elderly and disabled. In order to trick these consumers into agreeing to the genetic testing, sales pitches reportedly included scare tactics which pressured vulnerable people. They were allegedly told that they may end up suffering from fatal conditions if they didn’t get testing.

Once consumers agreed to give their information over, recruiters would allegedly try to get the patients’ genuine doctors to write a prescription for genetic testing. If they were unable to convince them, recruiters allegedly used one of their own many doctor partners despite these healthcare professionals reportedly having “zero contact with the patient and no knowledge of their health care situation or needs.”

Despite the tests being offered for free, these genetic testing orders would reportedly lead to Medicare reimbursements between $10,000 and $18,000, although some could be even more. This payment amount would reportedly be split between several people including recruiters, doctors, labs, and telemarketers.

“The scope and sophistication of the health care fraud detected in Operation Double Helix and the related Operation Brace Yourself is nearly unprecedented.  But the citizens of the Southern District of Georgia should know that we put together an unprecedented response,” U.S. Attorney Bobby L. Christine of the Southern District of Georgia said.

“Our office charged more defendants, responsible for more healthcare fraud losses, than ever before in this office’s history. While these charges might be some of the first, they won’t be the last.”

Federal Whistleblower Lawsuits

Often these sorts of fraudulent schemes are revealed in federal whistleblower lawsuits. These complaints are filed under the False Claims Act which allows a private citizen to take legal action on behalf of the federal government if they were witness to fraud of a government program. Often times, these citizens have a chance to recover compensation as part of any federal whistleblower settlement.

This article is not legal advice. It is presented
for informational purposes only.