https://www.justice.gov/usao-wdpa/p...lty-multiple-kickback-conspiracies-connection
Department of Justice
U.S. Attorney’s Office
Western District of Pennsylvania
FOR IMMEDIATE RELEASE
Friday, January 10, 2020
Pittsburgh-Area Lab Owner Pleads Guilty To Multiple Kickback Conspiracies In Connection With Almost $130 Million In Medicare Claims For Genetic Testing
Agrees To Pay More Than $77 Million in Restitution
PITTSBURGH, Pa. – A resident of Monroeville, Pennsylvania, pleaded guilty in federal court to three conspiracy counts and one substantive count related to the payment and receipt of unlawful kickbacks, United States Attorney Scott W. Brady announced today.
Ravitej Reddy, 52, pleaded guilty before United States District Judge William S. Stickman IV.
During his plea hearing, the defendant admitted that he owned two testing laboratories—Personalized Genetics, LLC, d/b/a Personalized Genomics (PGL), located in Pittsburgh, and Med Health Services Management, LP (MHS), located in Monroeville. Beginning as early as May 2018, and continuing through approximately April 12, 2019, the defendant admitted that he participated in three separate conspiracies related to Medicare billing for two types of genetic testing: cancer genomic testing (CGx) and pharmacogenetic testing (PGx). CGx testing used DNA sequencing to detect mutations in genes that could indicate a higher risk of developing certain types of cancers in the future. CGx testing, however, was not a method of diagnosing whether an individual presently had cancer. PGx testing detected specific genetic variations in genes that impacted the metabolism of certain medications. In other words, PGx testing helped determine, among other things, whether certain medications would be effective if used by a particular patient.
As part of his guilty plea, the defendant admitted that he and a group of co-conspirators—comprising business consultants, marketers, and the operator of a telemedicine entity, among others—acquired thousands of testing samples from Medicare beneficiaries located throughout the United States, as well as the corresponding physician-ordered prescriptions that PGL and MHS needed to bill Medicare for CGx and PGx testing. For their part, the marketers used targeted campaigns to induce beneficiaries to submit CGx and PGx specimens by means of cheek swabs sent to their homes or provided to them at purported "health fairs" held throughout the United States. Marketers, in turn, were paid percentage-based kickbacks depending upon the Medicare reimbursements for beneficiaries whose samples they had obtained and submitted to PGL or MHS.
Likewise, the operator of a Florida-based telemedicine entity allegedly was paid kickbacks in connection with obtaining CGx and PGx prescriptions from physicians who were contracted by his company to review the beneficiaries’ personal and familial medical histories. As alleged, contract physicians authorized testing for greater than 95% of beneficiaries despite the fact that the doctors did not conduct a proper telemedicine visit, were not treating the Medicare beneficiaries for cancer or symptoms of cancer, did not use the test results in the treatment of the beneficiaries, and generally were not qualified to understand and interpret the test results.
The defendant further admitted that he and his co-conspirators took advantage of PGL’s and MHS’s physical locations within the Medicare coverage area that offered the highest reimbursement rates in the United States. The court was further advised that the co-conspirators used PGL and MHS as the billing laboratory despite the fact that the labs did not possess properly validated equipment to conduct any CGx testing on-site and, as such, were forced to send samples for proper testing by a so-called reference laboratory that was located outside of the lucrative coverage area.
During the plea hearing, the defendant admitted to his participation in three separate kickback conspiracies related to the acquisition of CGx and PGx specimens—an initial conspiracy between May 2018 and April 12, 2019, involving Medicare billings through PGL and two side conspiracies between October 2018 and April 12, 2019, involving Medicare billings through MHS. The defendant further admitted that he engaged in the second and third conspiracies with some, but not all, of the same co-conspirators as the first conspiracy, and he pursued these alleged side deals, in part, as a means to increase his share of the profits relative to the first PGL-based conspiracy. Finally, the defendant pleaded guilty to a substantive charge of paying percentage-based kickbacks to another unrelated marketing entity in connection with the acquisition of PGx and other testing samples between October 2017 and April 2019.
The defendant admitted that he caused PGL and MHS to submit Medicare claims for CGx and PGx testing that regularly exceeded $12,000 per beneficiary. In total, between May 2018 and April 12, 2019, the defendant’s laboratories billed Medicare more than $127 million for CGx and PGx testing, with reimbursements of approximately $60 million.
Pursuant to a written plea agreement, the defendant further agreed to make restitution to the Centers for Medicare and Medicaid Services, a component of the U.S. Department of Health and Human Services, in the amount of $77,328,319.82.
For each of the three conspiracy counts, the defendant faces a maximum sentence of five years in prison, a fine of $250,000, or both. For the substantive kickback charge, he faces a maximum sentence of 10 years in prison, a fine of $250,000, or both. Under the Federal Sentencing Guidelines, the actual sentence imposed would be based upon the seriousness of the offense and the prior criminal history, if any, of the defendant.
Assistant United States Attorney Eric G. Olshan is prosecuting this case on behalf of the government. The Federal Bureau of Investigation and U.S. Department of Health and Human Services – Office of Inspector General conducted the investigation of the defendant.
Department of Justice
U.S. Attorney’s Office
Western District of Pennsylvania
FOR IMMEDIATE RELEASE
Friday, January 10, 2020
Pittsburgh-Area Lab Owner Pleads Guilty To Multiple Kickback Conspiracies In Connection With Almost $130 Million In Medicare Claims For Genetic Testing
Agrees To Pay More Than $77 Million in Restitution
PITTSBURGH, Pa. – A resident of Monroeville, Pennsylvania, pleaded guilty in federal court to three conspiracy counts and one substantive count related to the payment and receipt of unlawful kickbacks, United States Attorney Scott W. Brady announced today.
Ravitej Reddy, 52, pleaded guilty before United States District Judge William S. Stickman IV.
During his plea hearing, the defendant admitted that he owned two testing laboratories—Personalized Genetics, LLC, d/b/a Personalized Genomics (PGL), located in Pittsburgh, and Med Health Services Management, LP (MHS), located in Monroeville. Beginning as early as May 2018, and continuing through approximately April 12, 2019, the defendant admitted that he participated in three separate conspiracies related to Medicare billing for two types of genetic testing: cancer genomic testing (CGx) and pharmacogenetic testing (PGx). CGx testing used DNA sequencing to detect mutations in genes that could indicate a higher risk of developing certain types of cancers in the future. CGx testing, however, was not a method of diagnosing whether an individual presently had cancer. PGx testing detected specific genetic variations in genes that impacted the metabolism of certain medications. In other words, PGx testing helped determine, among other things, whether certain medications would be effective if used by a particular patient.
As part of his guilty plea, the defendant admitted that he and a group of co-conspirators—comprising business consultants, marketers, and the operator of a telemedicine entity, among others—acquired thousands of testing samples from Medicare beneficiaries located throughout the United States, as well as the corresponding physician-ordered prescriptions that PGL and MHS needed to bill Medicare for CGx and PGx testing. For their part, the marketers used targeted campaigns to induce beneficiaries to submit CGx and PGx specimens by means of cheek swabs sent to their homes or provided to them at purported "health fairs" held throughout the United States. Marketers, in turn, were paid percentage-based kickbacks depending upon the Medicare reimbursements for beneficiaries whose samples they had obtained and submitted to PGL or MHS.
Likewise, the operator of a Florida-based telemedicine entity allegedly was paid kickbacks in connection with obtaining CGx and PGx prescriptions from physicians who were contracted by his company to review the beneficiaries’ personal and familial medical histories. As alleged, contract physicians authorized testing for greater than 95% of beneficiaries despite the fact that the doctors did not conduct a proper telemedicine visit, were not treating the Medicare beneficiaries for cancer or symptoms of cancer, did not use the test results in the treatment of the beneficiaries, and generally were not qualified to understand and interpret the test results.
The defendant further admitted that he and his co-conspirators took advantage of PGL’s and MHS’s physical locations within the Medicare coverage area that offered the highest reimbursement rates in the United States. The court was further advised that the co-conspirators used PGL and MHS as the billing laboratory despite the fact that the labs did not possess properly validated equipment to conduct any CGx testing on-site and, as such, were forced to send samples for proper testing by a so-called reference laboratory that was located outside of the lucrative coverage area.
During the plea hearing, the defendant admitted to his participation in three separate kickback conspiracies related to the acquisition of CGx and PGx specimens—an initial conspiracy between May 2018 and April 12, 2019, involving Medicare billings through PGL and two side conspiracies between October 2018 and April 12, 2019, involving Medicare billings through MHS. The defendant further admitted that he engaged in the second and third conspiracies with some, but not all, of the same co-conspirators as the first conspiracy, and he pursued these alleged side deals, in part, as a means to increase his share of the profits relative to the first PGL-based conspiracy. Finally, the defendant pleaded guilty to a substantive charge of paying percentage-based kickbacks to another unrelated marketing entity in connection with the acquisition of PGx and other testing samples between October 2017 and April 2019.
The defendant admitted that he caused PGL and MHS to submit Medicare claims for CGx and PGx testing that regularly exceeded $12,000 per beneficiary. In total, between May 2018 and April 12, 2019, the defendant’s laboratories billed Medicare more than $127 million for CGx and PGx testing, with reimbursements of approximately $60 million.
Pursuant to a written plea agreement, the defendant further agreed to make restitution to the Centers for Medicare and Medicaid Services, a component of the U.S. Department of Health and Human Services, in the amount of $77,328,319.82.
For each of the three conspiracy counts, the defendant faces a maximum sentence of five years in prison, a fine of $250,000, or both. For the substantive kickback charge, he faces a maximum sentence of 10 years in prison, a fine of $250,000, or both. Under the Federal Sentencing Guidelines, the actual sentence imposed would be based upon the seriousness of the offense and the prior criminal history, if any, of the defendant.
Assistant United States Attorney Eric G. Olshan is prosecuting this case on behalf of the government. The Federal Bureau of Investigation and U.S. Department of Health and Human Services – Office of Inspector General conducted the investigation of the defendant.