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Two men charged with felony fraud for unnecessary Medicare claims

On Behalf of | Oct 9, 2019 | Firm News

Louisiana prosecutors charged two men with felony fraud in their alleged connections to a Medicare scheme that may have encompassed more than $240 million in unneeded services. If all of the allegations are true, it will be the largest health care fraud case in the nation’s history. As reported by KNOE 8 News, the two defendants purportedly set up and ran an operation engaged in selling unnecessary DNA testing kits.

Reportedly, the kits were not medically necessary, but a solicitation campaign promoted them to low-income and elderly Medicare recipients as specialized genetic cancer screening tests. The defendants allegedly had an elaborate and highly effective telemarketing campaign which persuaded thousands of individuals to request a test.

Investigators’ allegations of a kickback scheme

In order for the federal government to provide payment for a testing kit, the Medicare beneficiaries first had to obtain approval and a prescription for the test from a telemedicine doctor. Investigators, however, found evidence that the doctors who provided Medicare recipients with recommendations for the genetic tests did not actually know or treat the patients. After the telemedicine doctors approved a patient for a testing kit, the two men and their associates purportedly received payment through fraudulent means.

By sending the genetic test kits to various diagnostic laboratories, including one in Louisiana owned by one of the two men, the operation allegedly engaged in billing the federal government for unneeded medical services. Investigators say that the clinical testing laboratories submitted claims for testing-kit payments to Medicare for an amount totaling more than $240 million. In exchange for the testing-kit referrals, the laboratories allegedly provided the defendants, tele-doctors and solicitors with kickbacks from the government funds they received.

Felony fraud charges require an aggressive legal defense

While every felony charge is a very serious matter, a charge does not always result in a conviction. It is up to the prosecution to provide enough evidence to convince a jury that a defendant is guilty beyond a reasonable doubt of engaging in the alleged fraudulent activity. An aggressive defense strategy may be required to counteract the accusations that a prosecutor presents. Through due process, an accused individual has the constitutional right to fight the severity of the charges and avoid a harsh punishment.