Lab Owner Faces Kickback Charges Related to Nearly $130 Million in Medicare Claims

by Andrew Murray | December 16th, 2019

The Department of Justice announced criminal healthcare fraud charges against the owner of genetic testing laboratories on November 26, 2019. The defendant was charged with one substantive count and three conspiracy counts relating to kickback payments. The Press Release states:

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Ravitej Reddy, 52, was charged by criminal Information with two counts of conspiracy to pay and receive kickbacks, one count of conspiracy to pay kickbacks, and one count of offering and paying kickbacks.

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According to the Information, the defendant owned two testing laboratories—Personalized Genetics, LLC, d/b/a Personalized Genomics (PGL), located in Pittsburgh, and Med Health Services Management, LP (MHS), located in Monroeville. Beginning as early as May 2018, and continuing through approximately April 12, 2019, the Information alleges that the defendant participated in three separate conspiracies related to Medicare billing for two types of genetic testing: cancer genomic testing (CGx) and pharmacogenetic testing (PGx). CGx testing used DNA sequencing to detect mutations in genes that could indicate a higher risk of developing certain types of cancers in the future. CGx testing, however, was not a method of diagnosing whether an individual presently had cancer. PGx testing detected specific genetic variations in genes that impacted the metabolism of certain medications. In other words, PGx testing helped determine, among other things, whether certain medications would be effective if used by a particular patient.

As alleged, the defendant and a group of co-conspirators comprising business consultants, marketers, and the operator of a telemedicine entity, among others, acquired thousands of testing samples from Medicare beneficiaries located throughout the United States, as well as the corresponding prescriptions that PGL and MHS needed to bill Medicare for CGx and PGx testing. For their part, the marketers used targeted campaigns to induce beneficiaries to submit CGx and PGx specimens by means of cheek swabs sent to their homes or provided to them at purported “health fairs” held throughout the United States. Marketers, in turn, were paid percentage-based kickbacks depending upon the Medicare reimbursements for beneficiaries whose samples they had obtained and submitted to PGL or MHS.

According to the Information, the defendant and his co-conspirators took advantage of PGL’s and MHS’s physical locations within the Medicare coverage area that offered the highest reimbursement rates in the United States. As alleged, the co-conspirators used PGL and MHS as the billing laboratory despite the fact that the labs did not possess properly validated equipment to conduct any CGx testing on-site and, as such, were forced to send samples for proper testing by a so-called reference laboratory that was located outside of the lucrative coverage area.

The three charged conspiracies involve similar conduct related to the acquisition of CGx and PGx specimens. The first conspiracy, however, allegedly involved billings only through PGL, while the second and third conspiracies involved billings through MHS. According to the Information, the defendant engaged in the second and third conspiracies with some, but not all, of the same co-conspirators as the first conspiracy, and he pursued these alleged side deals, in part, as a means to increase his share of the profits relative to the PGL-based conspiracy. Finally, the Information charges one substantive kickback count, alleging that the defendant paid percentage-based kickbacks to another unrelated marketing entity in connection with the acquisition of PGx and other testing samples between October 2017 and April 2019.

According to the Information, the defendant caused PGL and MHS to submit Medicare claims for CGx and PGx testing that regularly exceeded $12,000 per beneficiary. In total, between May 2018 and April 12, 2019, the defendant’s laboratories billed Medicare more than $127 million for CGx and PGx testing, with reimbursements of approximately $60 million.

For each of the three conspiracy counts, the defendant faces a maximum sentence of five years in prison, a fine of $250,000, or both. For the substantive kickback charge, he faces a maximum sentence of 10 years in prison, a fine of $250,000, or both. Under the Federal Sentencing Guidelines, the actual sentence imposed would be based upon the seriousness of the offense and the prior criminal history, if any, of the defendant.

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