The Justice Department announced this week the results of a nationwide healthcare fraud investigation, resulting in charges against 324 defendants, including three in North Texas. The unprecedented investigation touched 50 federal districts and targeted schemes involving more than $14.6 billion in intended loss.
Last year, D CEO Healthcare investigated several local labs that had allegedly sent unwanted COVID-19 tests to Medicare patients nationwide. The addresses listed for the labs on patients’ explanation of benefits either did not exist or were abandoned, and none of the labs were present. Federal investigators have been investigating similar schemes across the country, and three cases of fraudulent billing to federal payers were part of the national takedown. The article raised the question of whether North Texas had a fake COVID-19 lab scheme problem, but our region is far from alone.
In North Texas, three individuals were charged with fraudulently billing federal payers and other insurance companies for approximately $200 million. Medical clinic owner and McKinney resident Gary Martin is accused of conspiracy to solicit or receive kickbacks for referrals to the federal healthcare program connected to $73 million in false or fraudulent claims. The indictment says he conspired with providers and others to pay and receive kickbacks based on Medicare reimbursements for over-the-counter COVID-19 tests. Martin and others provided Medicare with patient information without the patient’s knowledge or consent and requested COVID-19 tests. At times, the alleged beneficiary was deceased. After Medicare paid for the test, a co-conspirator paid a kickback based on the reimbursement. Martin’s co-defendant, Damon Heath Roberts, previously pleaded guilty to his role in the scheme…