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  • Writer's pictureJames A. Gustino

I was shocked initially by the frequency and varied nature of the Medicare schemes perpetrated (reminiscent of corruption found in many Third World countries), but not any longer.

Medicare and Medicaid fraud apparently pays (and pays well) since it continues to be rampant. In fact, it is believed that only a small fraction of these fraudulent activities is ultimately exposed and taxpayer recoveries realized.

 //[As alleged], McNAMARA and SPIVEY orchestrated a scheme to defraud Medicare by billing for cancer genetic testing and cardiovascular genetic testing that was ineligible for Medicare reimbursement because the testing was not medically necessary and was procured through the payment of illegal kickbacks and bribes. McNAMARA and SPIVEY operated several laboratories, which obtained doctors’ orders for genetic testing from telemarketers and call centers that used aggressive telemarketing campaigns to induce Medicare beneficiaries to agree to receive genetic testing. Orders for genetic testing were signed by purported telemedicine doctors who were not the beneficiaries’ treating physicians, did not perform consultations with the beneficiaries, and did not follow up with the beneficiaries after the testing was performed. The superseding indictment alleges that from in or around November 2018 through July 2020, the laboratories operated by McNAMARA and SPIVEY submitted over $174 million in false and fraudulent claims to Medicare for genetic testing and received over $55 million in reimbursements. *** The government seized several luxury vehicles and over $7 million in bank accounts.//

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