Telemarketing Company Operators Sentenced for Medicare Genetic Testing Fraud

The bottom line: a telemarketing operation that recruits Medicare beneficiaries for tests they do not need is committing health care fraud, and its operators can be prosecuted as such.

The genetic testing scheme

According to court documents, Wexler and Bleignier operated a telemarketing company that recruited Medicare beneficiaries for cancer genetic (CGx) testing that was medically unnecessary. CGx testing uses DNA sequencing to detect gene mutations that could indicate a higher risk of certain cancers in the future. It does not diagnose whether a person currently has cancer, and Medicare covers it only in limited circumstances.

Wexler, Bleignier and their co-conspirators also solicited and received kickbacks for referring beneficiaries for CGx testing that was not eligible for Medicare reimbursement. The scheme caused Medicare to be billed $17.3 million, and the two were paid $5.2 million.

The laboratory scheme

While the genetic testing case was pending, Bleignier opened a clinical laboratory and enrolled it in Medicare. Medicare requires a certification listing anyone with an ownership interest of 5% or more. Bleignier used other people's identities to hide his involvement. The laboratory's claims were further tainted by kickbacks. Bleignier and his co-conspirators billed Medicare $3,012,156 in ineligible claims and were paid $916,106.

Pleas and penalties

• Wexler pleaded guilty in April 2024 to conspiracy to commit health care fraud and wire fraud.
• Bleignier pleaded guilty in November 2022 to conspiracy to defraud the United States and pay and receive kickbacks, and in November 2024 to making false statements related to health care matters.
• Each was ordered to pay $1.2 million in forfeiture, and they were ordered to pay $5.2 million in restitution.
• Bleignier was ordered to pay an additional $916,106 in forfeiture.

The Department of Health and Human Services Office of Inspector General (HHS-OIG) and the Federal Bureau of Investigation (FBI) investigated. The Criminal Division's Fraud Section prosecuted the case.

Why it matters

When telemarketers are paid per referral for tests Medicare will not cover, both the marketers and the payers face kickback and fraud charges.

What this means for you

1. Do not accept per-referral payments for Medicare beneficiaries from labs or suppliers.
2. Do not run campaigns pitching genetic tests to seniors as free or covered without real medical need.
3. Ownership disclosures to federal programs must be truthful and complete.
4. In this case, new fraud committed while the first case was pending led to an additional conviction.

Selling health care services through telemarketing requires extra caution, and Medicare campaigns require the most.