False Diagnosis

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Man giving bribe to a doctor

While COVID-19 has caused hardship for many, it has promoted advancements in telemedicine, which physicians turned to as a way to provide health care services to their patients. As stay-at-home orders were issued across the U.S., a report states that telehealth utilization was 38 times higher than before the pandemic. As you might guess, unscrupulous individuals were plotting and scheming as the pandemic progressed on how to use this new service to steal government healthcare benefits. (Fraudsters are always looking for new opportunities to steal from vulnerable citizens and large government benefit programs.)

Elizabeth Turner, of Glenview, Ky., who owned telemedicine company Advanced Tele-Genetic Counseling (ATGC), has pleaded guilty to her involvement in a telemedicine healthcare conspiracy. Her company received kickbacks from marketers in exchange for providing signed doctors’ orders for Cancer genomic (CGx) testing.

In CGx testing, DNA sequencing is used to detect mutations in genes that could indicate a higher risk of developing certain types of cancers in the future. (Not to be confused as a cancer diagnosis method.) The “marketers” (aka Turner’s puppets) targeted Medicare and Medicaid patients (predominately senior citizens), going door-to-door at nursing homes and senior citizen fairs. They convinced the unsuspecting patients to provide a genetic sample through mouth swab kits. Then, they provided these swab kits to Crestar Labs for CGx testing. Crestar Labs billed Medicare and Medicaid for the tests, and the “marketers” received kickbacks from Crestar Labs. (There was a lot of back scratching and kickbacks going on there.)

Turner had a little help from co-conspirators including Fadel Alshalabi, the owner of Crestar Labs, LLC based in Spring Hill, Tenn., and Melissa Lynn “Lisa” Chastain, the owner of marketing company Genetix, LLC in Belton, S.C., among others, to defraud the Medicare and Medicaid programs. Turner offered, paid, solicited and received illegal kickbacks.

Turner used ATGC to pay kickbacks to physicians for signed orders for CGx tests, even though they were medically unnecessary. She not only knew that these doctors were not treating the patients for any specific medical problems, but also that some of these doctors never even contacted the patients at all.

Turner’s company received around $234,730 in illegal kickback payments from marketing company co-conspirators including Genetix, LLC. Medicare and Medicaid paid laboratories (including Crestar Labs, LLC) millions in reimbursements they were not entitled to receive because the CGx tests were ineligible for reimbursement due to the nature of their procurement.

When sentenced, Turner faces up to five years in prison, a fine of up to $250,000, restitution to the Medicare and Medicaid programs, and forfeiture of the ill-gotten proceeds. (We can be sure that the justice system will provide an accurate fraud  diagnosis and an appropriate cure.)

Today’s Fraud of the Day comes from a Department of Justice press release, “Owner Of Telemedicine Company Pleads Guilty To Health Care Fraud Conspiracy” dated December 21, 2021.

NASHVILLE – A Kentucky woman pleaded guilty yesterday in U.S. District Court in Nashville, to conspiracy to pay and receive health care kickbacks, announced Acting U.S. Attorney Mark H. Wildasin for the Middle District of Tennessee.

Elizabeth Turner, 34 of Glenview, Kentucky, was charged by criminal Information in November with conspiring with Fadel Alshalabi, the owner of Crestar Labs, LLC, based in Spring Hill, Tennessee, Melissa Lynn “Lisa” Chastain, the owner of marketing company Genetix, LLC, located in Belton, South Carolina, as well as other marketers and physicians, to offer, pay, solicit and receive illegal kickbacks and to defraud the Medicare and Medicaid Programs.

 

 

 

 

 

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.