Fraudulent Genetic Testing Scheme Exposed: A Mother of Five Sentenced to 20 Years
The Scheme
Body camera video shows the moment Elizabeth Hernandez called Miami-Dade Police to her home in 2019 reporting she was the victim of a crime. But federal investigators say Hernandez was the one breaking the law. She claimed someone else was billing in her name, but investigators discovered she was involved in a genetic testing scheme that cost taxpayers millions.
The Investigation
Stephen Mahmood, Assistant Special Agent in Charge of the Miami regional office for the U.S. Department of Health and Human Services Office of the Inspector General, explained that investigators identified several providers who were ordering a lot of genetic testing, and Hernandez was the number one. She would also bill Medicare for a telehealth visit for a person she never saw, a person she never spoke to on the telephone.
The Scheme Works
Mahmood explained that telemarketing companies contact Medicare recipients, using illegally obtained personal data. They then get doctors or other providers to sign off on unnecessary genetic testing, supposedly for cancer or heart conditions, in exchange for a kickback.
The Results
Investigators say many of the people targeted by call centers were elderly and vulnerable. Some didn’t even remember agreeing to the test. And when results were sent back to them, they were gobbledygook, they garbage. The lab bills Medicare thousands for the tests, and everyone gets a cut.
The Consequences
Hernandez was among several people charged in connection to genetic testing fraud. In December, she was sentenced to 20 years behind bars. She sent a lengthy email from prison, writing that she only ordered tests for patients that met the medical necessity requirements and that the lab was committing the fraud. But a jury found this was a true story, and investigators say the evidence backs it up.
The Evidence
Evidence included Hernandez’ monthly deposits, which showed her income skyrocketed in 2020, at one point reaching more than $280,000 for just one month of remote telehealth work. In all, prosecutors said Hernandez pocketed approximately $1.6 million in the scheme. Investigators shared text messages that show a conversation between Hernandez and a friend, celebrating how many orders they signed one month. One reads, "we have to be over 500 pts (patients) by now…". Then, she sent a meme with the words, "We getting’ money".
Conclusion
This scheme puts pressure on the Medicare program, creating billions of dollars going out the door just to line the pockets of criminals, thieves. That’s your money that you’re putting into the system that person is using.
FAQs
Q: What is the genetic testing scheme?
A: The genetic testing scheme involves telemarketing companies contacting Medicare recipients, using illegally obtained personal data, and getting doctors or other providers to sign off on unnecessary genetic testing, supposedly for cancer or heart conditions, in exchange for a kickback.
Q: Who was involved in the scheme?
A: Elizabeth Hernandez, a mother of five, was among several people charged in connection to genetic testing fraud.
Q: What was the outcome of the scheme?
A: Hernandez was sentenced to 20 years behind bars, and is appealing her case.
Q: What can I do if I suspect a provider is engaging in telefraud?
A: You can contact the Office of the Inspector General for HHS at 1-800-447-8477 or visit TIPS.HHS.GOV.
