Federal settlement resolves fraud allegations involving kickbacks and unnecessary genetic testing claims.
Access DX Laboratory, a medical testing company based in Houston, Texas, along with its former chief executive and a Florida businessman, will pay a combined $36.4 million to settle claims that they took part in an illegal healthcare billing scheme involving genetic testing. Federal officials said the case involved improper payments for patient referrals, false medical orders, and billing government healthcare programs for tests that were not medically needed. According to the U.S. Department of Justice (DOJ), the alleged conduct took place in the two-year span between January 2018 and January 2020. During that time, prosecutors said the laboratory, former CEO Michael Stewart, and Florida businessman Harold Shatz paid marketers to send patients to the company for testing. Federal law generally bans payments made in exchange for patient referrals because medical decisions are expected to be based on a person’s health needs rather than financial rewards.
Investigators also claimed the group broke billing rules by separating genetic testing charges into multiple claims instead of billing everything together under a single claim. Additionally, telehealth providers were paid for doctors’ orders that were not based on proper medical judgment. Those orders were then used to bill Medicare and Medicaid for genetic testing that prosecutors said was not necessary.
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