Prestige Administrative Services, LLC d/b/a Prestige Healthcare (Prestige), headquartered in Louisville, Kentucky has agreed to pay the United States to resolve genetic testing fraud allegations that it violated the False Claims Act. The Medicare false billing allegations involved unnecessary and fraudulent genetic testing. Prestige is an owner/operator of nursing homes in several states, including four facilities owned and operated in Wisconsin (Wisconsin Rapids, Rhinelander, Oshkosh, and Milwaukee).
The United States alleged that in 2014, Prestige was approached by Genomix, LLC, which claimed it could perform genetic testing on Prestige’s Medicare residents to determine whether Prestige’s patients were properly metabolizing their medications. According to the allegations, Prestige provided Genomix with insurance, personal medical information and access to patients in nursing homes in Wisconsin and several states for purpose of conducting the testing. Genomix conducted the testing by taking cheek swabs of each Prestige patient and then sending the cheek swab to a laboratory for analysis.
Nursing home operators, like Prestige, place orders with clinical laboratories for medically necessary diagnostic laboratory tests for their residents. In order to be considered medically necessary and thus reimbursable under Medicare, the laboratory test must be ordered by the physician treating the resident.
The United States alleged that Prestige failed to ensure that physician orders were obtained for the genetic testing prior to its being conducted, and that Prestige physicians were not aware of and did not agree with the medical necessity of the testing. The United States also alleged that Prestige failed to ensure that its patients (or, in some cases, their family members responsible for their medical decisions) were appropriately informed of the testing prior to its being conducted and provided with the opportunity to decline the testing.
According to the United States, the lack of physician orders and patient consent in this case was discovered during a survey conducted by state regulators in late 2015.
Lamont Pugh III, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services remarked:
As genetic testing technology is evolving, we see the same types of clinical testing abuses that are evident in more established testing…along with our law enforcement partners, we will investigate and prosecute violations in these newer health care technologies.
More information for potential Medicare fraud whistleblowers is located at the Nolan Auerbach & White main website.