Lab test fraud can be very lucrative, with potential profits in the hundreds of millions and even billions of dollars. In one recent December 2022 case, a federal jury in the Southern District of Florida convicted the owner of Atlanta-based LabSolutions LLC for his role in a scheme to defraud Medicare by submitting over $463 million in genetic and other lab tests that patients didn’t need and were procured through kickback payments. The lab owner did this by conspiring with patient brokers, telemedicine companies, and call centers to target Medicare patients with telemarketing calls to convince them to undergo expensive tests to find genetic predispositions to certain cancers, even though such tests were not medically necessary.

After patients agreed to take a test, the lab owner paid bribes to patient brokers to obtain signed doctors’ orders authorizing the tests from telemedicine companies. And to hide kickback payments, patient brokers were required to sign contracts that falsely stated that they were performing legitimate advertising services for LabSolutions. The case also revealed that telemedicine doctors who approved testing often did not even treat or speak to the patients they signed off on tests for. In the end, the jury found that LabSolutions submitted more than $463 million in claims to Medicare, most of which was for medically unnecessary genetic tests, and the lab owner personally pocketed over $21 million of the Medicare proceeds.

The Scope of Lab Test Fraud

Health care fraud remains a top priority of the Department of Justice (DOJ). In a recent statement, the DOJ announced that over $1.7 billion of the $2.2 billion in False Claims Act settlements and judgments in 2022 involved health care fraud. Some recent high-profile cases shed light on just how wide in scope lab test fraud is. For instance, in 2019, the DOJ charged 35 individuals responsible for over $2.1 billion in losses for fraudulent genetic cancer testing. And in July 2022, the DOJ  announced criminal charges against another 36 individuals for more than $1.2 billion in fraudulent testing.

How You Can Help Stop Lab Test Fraud

As enforcement of lab test fraud picks up and fraudsters turn to increasingly sophisticated methods to evade detection, whistleblowers are more important than ever. Whistleblowers are often lab employees, healthcare providers, or telemedicine employees. If you have information about a lab test fraud scheme, you may qualify to be a whistleblower and can earn a 15 to 30 percent share of the settlement for coming forward with evidence that helps seal a conviction. You should contact an experienced whistleblower attorney to learn more about your rights and protections.

Contact Baron & Budd

With more than 30 years of experience, the attorneys on Baron & Budd’s whistleblower representation team have represented dozens of clients in government fraud cases returning over $6.0 billion to federal and state agencies, with whistleblower recovery shares as high as 49%. They are ready to help if you have evidence of lab test fraud.

Please call (866) 845-2164 or complete our contact form if you would like more information. For more information, see What You Need to Know About Becoming a Whistleblower. Please understand that contacting us does not mean that you have established an attorney-client relationship with Baron & Budd, P.C.