Big Medicare fraud ring busted in Houston. How big? $142 million big.
The Office of the Attorney General’s (OAG) Medicaid Fraud Control Unit (MFCU) has made a series of arrests and seized assets related to a fraud case in Houston.
Lily Tran Daniel, Kenneth Reynolds, and Lillian Thai were all arrested on suspicion of their “involvement in a major healthcare fraud scheme” associated with ApolloMDx, a genetic testing company.
According to a release from the OAG, AplloMDx had involvement in a $142 million healthcare fraud scheme where they would offer illegal kickbacks in order to purchase recipient information form marketers and orders for genetic testing from doctors.
The statement from the OAG details how ApolloMDx would make alterations on the dates of service on testing orders, making it appear that they collected multiple DNA samples on different dates, so they could bill for multiple dates of service to increase their Medicare reimbursement on genetic testing claims.
Since the inception of the national Medicare Fraud Strike Force to crack down on Medicare fraud in 2007, Texas has been at the center of many investigations, including what was at the time the country’s largest-ever Medicare fraud takedown in Dallas.
Medicare and Medicaid are two U.S. government programs that were created in the 1960s to provide low-income citizens with a rudimentary form of health insurance coverage. While Medicare covers persons age 65 and older, Medicaid was established for persons under 65 years and those over that age who had exhausted their Medicare benefits. It is also funded jointly by the federal and state governments.
The Texas MFCU worked in conjunction with the Department of Health and Human Services’ (HHS) Office of Inspector General and the Federal Bureau of Investigation to investigate the ApolloMDx case. The prosecution will be carried out by the U.S. Department of Justice’s Health Care Fraud Strike Force. The U.S. Attorney’s Office for the Southern District of Texas is assisting with forfeiture.
In addition to uncovering the fraud scheme, the MFCU seized sports cars, a sailboat, and three properties for a total of $7.1 million, funded by the illegal proceeds accrued from the ApolloMDx operation.
Texas and the federal government jointly finance and administer Medicaid and the Children’s Health Insurance Program, which comes to a total of over $40 billion.
The more money that flows through public welfare systems, the more susceptible to fraud they are. And it wouldn’t surprise me to learn that all the additional money flooding the system has made it that much easier for people to commit fraud.