Dive Brief:

• A Las Vegas cardiology practice has settled a case alleging it received kickbacks from genetic testing companies in return for patient referrals, the latest amid increasing scrutiny of improper billing of Medicare for genetic testing.

• Nevada Heart & Vascular Center allegedly referred patients to Natural Molecular Testing and Iverson Genetic Diagnostics for money over a nine-month period across 2012 and 2013.

• To settle the case, NHVC has agreed to pay $2.5 million without admitting to liability.

Dive Insight:

The U.S. government alleges NHVC violated the Anti-Kickback Statute and the civil False Claims Act by referring patients to the two testing laboratories from September 2012 to May 2013 in return for payments.

Officials at HHS, FBI and other government departments investigated the case, which overlaps with others brought by U.S. officials. One of the diagnostic laboratories, Natural Molecular Testing, was previously found to owe Medicare $71 million. The laboratory allegedly paid doctors who ordered its tests as much as $10,000 a month in consulting fees.

CMS suspended payments to Natural Molecular Testing in April 2013, toward the end of the period in which NHVC allegedly received kickbacks. Natural Molecular Testing filed for bankruptcy shortly after the cessation of Medicare payments. Iverson Genetic Diagnostics filed for bankruptcy two years later.

The cases are part of an uptick in cases involving improper billing for genetic tests. In 2019 alone, GenomeDx Biosciences has agreed to pay $2 million to settle allegations it billed Medicare for medically unnecessary prostate cancer tests; the Center for Human Genetics reached a $500,000 overbilling settlement and a man received a 50-month prison sentence for submitting fraudulent test claims.

The case that led to the prison sentence highlights how some are bypassing physicians and going straight to patients for samples they can use to justify Medicare claims. Earlier this month, the Office of Inspector General highlighted such practices, noting “scammers are offering Medicare beneficiaries cheek swabs for genetic testing to obtain their Medicare information for identity theft or fraudulent billing purposes.”

People running these schemes often target senior-living communities and low-income neighborhoods and enlist the support of a testing laboratory to make the Medicare claims.