Two men sentenced to prison in $522 million genetic testing fraud scheme
A federal court sentenced two men to 151 months and 36 months in prison for submitting over $522 million in fraudulent claims for medically unnecessary genetic tests. The sentences advance the Justice Department’s National Fraud Enforcement Division initiative that has now reached nearly $1 billion in total fraud recoveries.
foxnews.comTwo men received prison sentences Monday for their roles in a scheme that generated more than $522 million in fraudulent claims for genetic tests that patients did not need.
The Justice Department’s National Fraud Enforcement Division announced the sentences as part of a nationwide push that has now produced enforcement actions totaling nearly $1 billion. One defendant received 151 months in prison and the other received 36 months. The claims targeted Medicare, Medicaid, and private health insurance companies.
The scheme involved submission of bills for genetic tests that physicians had not ordered and that served no documented medical purpose. Medicare covers genetic testing only when the test guides treatment decisions for a specific beneficiary’s diagnosed condition.
Medicaid operates under similar medical-necessity rules in each participating state. Private insurers follow comparable standards in employer-sponsored and individual-market plans.
The sentences conclude one branch of the investigation but leave open further prosecutions and restitution collection. Federal prosecutors must now calculate and pursue asset forfeiture and restitution orders tied to the $522 million in false claims.
The Centers for Medicare and Medicaid Services will apply the enforcement outcome to strengthen prepayment edits and post-payment audits for genetic-testing claims nationwide. Laboratories, ordering physicians, and marketing entities that participated in the kickback arrangements face heightened scrutiny and potential exclusion from federal health programs.
The sentences form one piece of the Fraud Division’s broader 2026 campaign. The division’s May 8 release states that its recent actions across the country now total nearly $1 billion in fraud. The genetic-testing case is the second sentencing announced this week within that initiative.
Earlier cases in the same sweep have produced guilty pleas and civil settlements focused on laboratory kickbacks routed through telemedicine companies.
Primary sources: U.S. Department of Justice · U.S. Department of Justice
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