In September of 2019, the Department of Health and Human Services Office of Inspector General announced the takedown of a massive healthcare scam resulted in $2.1 billion in losses to Medicare. In this scheme, fraudsters would recruit Medicare beneficiaries at health care fairs or by telemarketing to take to take a “free” genetic test. Remember, nothing is free!
Normally, the doctor signs the orders for a medical test after a patient examination. Then the test is taken and forwarded to a lab for processing. Jokes aside about a doctor’s messy signature, the signature is essential to the processing of medical orders. It’s a testament that the services were provided accurately by a professional. But when stealing from the U.S. taxpayer, the process gets mixed around. In this scheme, recruiters targeted by telemarketing campaigns and at health fairs, where they were essentially enticed to take the genetic test with the word “free”. But remember, nothing is ever free.
The recruiters would then forward the Medicare beneficiary’s information to Dr. Daniel Canchola who signed the illicitly obtained orders for cancer genetic testing, knowing that the testing was unnecessary. The orders signed by Canchola were used to submit more than $54 million in false and fraudulent claims to Medicare. Many of these beneficiaries never actually received their test results, but their Medicare accounts were billed for thousands of dollars. And unfortunately, some of the people may never qualify for legitimate DNA tests in the future.
Excellent job the Department of Health and Human Services Office of Inspector General HHS-OIG in this case.
Today’s Fraud of The Day is based on article “North Texas doctor sentenced to prison in sweeping $54 million Medicare fraud case” published by The Dallas Morning News on October 31, 2024
North Texas doctor was sentenced to 10 years and one month in prison Tuesday for a scheme to defraud Medicare out of millions of dollars, authorities said. Dr. Daniel Canchola, 54, of Flower Mound, accepted bribes and kickbacks for ordering bogus cancer screening tests and medical equipment, the Justice Department said. Canchola, who pleaded guilty in 2022 to conspiracy to commit wire fraud, was also ordered to pay $34 million in restitution.
Federal prosecutors say Canchola signed scores of phony doctor’s orders for genetic cancer tests without examining or speaking to patients, who were recruited at health fairs and by telemarketers.
