ATLANTA - There's been a nationwide crackdown on doctors and labs that court documents claim have defrauded Medicare to the tune of $1.7 billion over unnecessary genetic tests.
Federal agents prepped in the dark for the recent sunrise raid of Clio Laboratories in Lawrenceville.
Nationally, there are 35 defendants, but 19 of them come from Georgia. The government says they are doctors, nurses, labs and marketers who have been federally charged with the scheme. The charges range from conspiracy to commit healthcare fraud to "illegal healthcare kickbacks and bribes."
“Medicare is getting bilked for billions of dollars for tests that are not needed, not necessary, and have never been received,” Derrick Jackson from Health and Human Services Office of the Inspector General said.
He told the Fox 5 I-Team that nearly every part of the healthcare industry is getting in on offering unneeded DNA tests to the elderly then billing Medicare for it.
“You have labs that hire marketers that go into senior citizen high rise buildings. They go to county fairs. They take cheek swabs for genetic testing, and beneficiaries have no relationship to the doctors. And, Medicare is being billed billions of dollars,” he added.
The Fox 5 I-Team warned our viewers a few months back about genetic testing fraud when members of a Covington community reported to police something similar. They said people were going door to door offering to test their DNA.
Fowler Homes resident Gay Cain remembers their pitch.
“He had on scrubs; he had on a name tag; he had everything like a professional has.”
She said the two men claimed to be screening for cancer. "It's free," they were told. But it's not. These tests can run up to $9,000 a pop and Medicare and Medicaid get the bill.
No charges have been filed in the Covington case, but Special Agent Jackson says the scheme sounds familiar. And in the end, what do people get out of this testing? Jackson says not much.
“Often times the beneficiary never sees the results, and if they do see the results, they don't know how to read them because their primary physician never ordered the test.”
These tests, the criminal complaints show, are ordered by tele-doctors - real physicians who've most likely never met the patient in person.
“Often times these companies are dealing with tele-medicine doctors who don't know these patients and who are being paid a kickback for every signature that they sign they get a monetary value for that,” the HHS-OIG agent told us.
Special Agent Jackson made it clear, this is not legal.
The Fox 5 I-Team crunched some of Health and Human Services recent data on the uptick in cases being billed for these genetic tests. We found in Georgia over the last two years, a 187 percent increase in Medicare billing for these tests.
“We are supposed to protect our elderly population, and so it's critical we work these cases. We get bad providers out of the business of defrauding the elderly,” Special Agent Jackson said.