Step Right on Up

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Medicare enrollment form and glasses

“Step right on up and get your free cancer screening test here!” (That’s what I imagine Terri Haines, 57, of Kennett Square, Penn., may have said while swabbing her elderly victims for DNA samples.) The former medical laboratory sales representative, who made a living soliciting and collecting DNA samples for genetic tests at health fairs, is now in some serious trouble for participating in a kickback and bribery scheme.

Health fairs can play an important role in preventing or delaying the onset of chronic disease. These events can provide opportunities for screenings by registered nurses, health educators, and other medical professionals at locations where they can assess the risk level of potential disease in a casual, informative setting. Haines is the fifth defendant to plead guilty to Medicare fraud related to this particular scheme in the Scranton area. (She took advantage of many elderly individuals to collect some extra cash for herself.)

Here are a few important details that you ought to know about Haines. She was not a health care provider, but she accepted commissions (kickbacks) from a lab in New Jersey that performed “CGx” cancer screen testing. CGx tests for a genetic predisposition to cancer. Willing participants typically hand over their Medicare number before having their cheek swabbed. Scammers typically offer “free” genetic testing touting that they help individuals avoid diseases or find the right medications. (But it’s not free. They stick Medicare with the bill.)

Haines could not carry out the scheme on her own. She needed approval for the CGx tests from a doctor. She paid kickbacks and bribes to Dr. Lee Besen of Scranton to use his name and medical credentials to order the tests from the New Jersey-based lab. It’s important to note that Besen never attended any of the health fairs with Haines, nor did he meet any of the patients for which the DNA tests were ordered. (Medicare paid out $340,000 for the tests that Besen signed off on.)

Besen previously pleaded guilty for his role in the Medicare fraud scheme and another related scheme that involved receiving kickbacks and bribes for DNA samples from Medicare patients that were sent to laboratories in New Jersey and Pennsylvania.

When sentenced for committing Medicare fraud in March 2022, Haines is facing a maximum of five years in prison and a fine of $250,000, or twice the gross gain or loss derived from the offense, whichever is greatest. (I can almost hear the judge saying, “Step right on up to my bench to receive your punishment, fraudster.” Have I got a perfect sentence for you!”)

Today’s Fraud of the Day comes from an article, “Kennett Square woman pleads guilty to violating health care anti-kickback laws,” published by Philadelphia Business Journal dated November 18, 2021.

A Chester County woman pleaded guilty Wednesday to conspiring to violating anti-kickback laws in a case involving genetic testing and senior adults.

The plea was entered by Terri Haines, 57, of Kennett Square, who formerly worked as a medical laboratory sales representative.

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Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.