A Georgia woman was arrested Friday for her alleged role in a conspiracy to defraud Medicare, a federally funded health care benefit program, by submitting false and fraudulent claims for cancer genetic (CGX) testing, as well as her role in conspiring to submit fraudulent claims related to COVID-19 and other tests.
Ashley Hoobler Parris, aka Ashley Hoobler and Ashley Parris, 32, of Lawrenceville, Georgia, is charged by complaint with conspiring to violate the Anti-Kickback Statute and conspiring to commit health care fraud. Hoobler was arrested Friday morning and had her initial court appearance Friday afternoon before U.S. Magistrate Judge Justin S. Anand of the Northern District of Georgia.
“The defendant allegedly sought to pay and receive illegal kickbacks in exchange for referring Medicare beneficiaries for expensive genetic screening tests and COVID-19 tests,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division. “The department will continue to work with our law enforcement partners to protect the public from those who defraud our government health care programs, especially those who exploit the COVID-19 pandemic for personal gain.”
“Fraud related to COVID-19 is particularly disturbing as it exploits a national crisis for personal gain,” said U.S. Attorney Maria Chapa Lopez of the Middle District of Florida. “The U.S. Attorney’s Office and our law enforcement partners remain focused on investigating and prosecuting individuals seeking to defraud federal government programs for personal profit, especially during this pandemic.”
“Let this arrest be a warning that our agents remain vigilant in our fight against healthcare fraud and improper billing of federal healthcare programs,” said Omar Pérez Aybar, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “With our law enforcement partners, we will continue to hold accountable those who attempt to enrich themselves at the government’s expense.”
The complaint alleges that, starting in or around October of 2018, and continuing through the present, Hoobler solicited and received illegal kickback payments from the owners and operators of a diagnostic testing laboratory in exchange for referring Medicare beneficiaries to this laboratory. The complaint further alleges that the owners and operators of the laboratory then submitted claims to Medicare for cancer genetic testing for the beneficiaries referred by Hoobler that were not eligible for reimbursement. The laboratory paid Hoobler a percentage of the paid claims as kickbacks.
Initially, the scheme related to Hoobler’s receipt of kickbacks for submitting CGX tests to diagnostic testing facilities. CGX testing is a type of test that uses DNA sequencing to detect mutations in genes that could indicate a higher risk of developing certain types of cancers in the future. CGX testing is not a method of diagnosing whether an individual presently has cancer. Generally, in order to have CGX tests conducted, an individual must complete a buccal or nasopharyngeal swab, or a respiratory sample, to collect a specimen, which specimen can then be transmitted to a laboratory for testing. Medicare rules and regulations provide that CGX testing is only reimbursable under certain specific circumstances, and tests not ordered by the physician who is treating the Medicare beneficiary are not considered reasonable and necessary.
The complaint alleges that Hoobler and her co-conspirators would obtain Medicare patient information and swabs by having Medicare beneficiaries complete genetic test kits, without regard to their medical necessity. Hoobler and her co-conspirators would obtain doctors’ orders for CGX testing for those beneficiaries by paying illegal kickbacks to co-conspirators at telemedicine companies. Hoobler also received illegal kickbacks in exchange for sending the completed CGX swabs and doctors’ orders to a laboratory. The laboratory would then submit false and fraudulent claims to Medicare.
Starting in or around February 2020, the effects of the COVID-19 pandemic began to be felt in the United States. According to the allegations in the complaint, as the COVID-19 crisis began to escalate, certain laboratory owners and operators have been willing to pay illegal kickbacks in exchange for completed COVID-19 and Respiratory Pathogen Panel (RPP) tests, which reimburse at a much higher rate than the COVID-19 tests.
The complaint further alleges that Hoobler agreed with others to be paid kickbacks on a per-test basis for COVID-19 tests, provided that those tests were bundled with more expensive RPP tests. Medicare’s reimbursement rates for the RPP tests are approximately four times higher than the reimbursement rates for the COVID-19 test.
HHS-OIG’s Miami Regional Office investigated the case with assistance from the Atlanta Regional Office and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Middle District of Florida. Trial Attorney Alejandro J. Salicrup is prosecuting the case.
A complaint is merely an allegation, and the defendant is presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
The Fraud Section leads the Medicare Fraud Strike Force. Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.