A 32-year-old woman from Lawrenceville, Georgia was arrested on Friday for her suspected role in a scheme to dupe the federally aided health program, Medicare, by presenting fraudulent and false claims for expensive cancer genetic (CGX) testing. She is also charged for being a part of a conspiracy to commit present similar claims for COVID-19 and other related tests.
Ashley Hoobler Parris, aka Ashley Parris and Ashley Hoobler, is being charged with conspiracy to violate the Anti-Kickback Statute and to commit health care fraud. "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 US Department of Health and Human Services
The Modus Operandi
Beginning sometime in October 2018, Hoobler began approaching operators and owners of a diagnostic testing laboratory and accepting unlawful kickbacks from them in lieu of sending beneficiaries of the health scheme to the lab. It is also alleged that the lab presented claims to Medicare for cancer tests for parties referred by her despite them not meeting eligibility criteria. At the end of it, Hoobler received a percentage of the paid claim.
The test in question, CGX—tests for hereditary cancer genes—is one that analyses genetic mutations to ascertain the risk of having certain forms of cancers in the future. It is not a method of detecting cancer Samples for the test are collected through swabs or from the lungs. Reimbursements for CGX testing is possible only under specific conditions and requires to be ordered physicians treating the beneficiaries provided it is essential.
Obtaining Doctor's Orders Illegally
Irrespective of whether the Medicare beneficiaries needed CGX testing, Hoobler and her associates would collect information and swabs from them. According to court records, they illegally obtained doctor's orders for the cancer test from co-conspirators at telemedicine companies in exchange for kickbacks. In addition to this, Hoobler also received payments from the laboratory for sending doctor's orders and completed swabs. Following this, fraudulent and fake claims would be presented to the government-funded health scheme.
Exploiting Fears Surrounding the COVID-19 Pandemic
Ever since the pandemic began taking hold in the US in February 2020 and escalating, laboratory owners and operators began looking at it as an opportunity to defraud the scheme. The complaint states that they have been open to illegal payouts in exchange for Respiratory Pathogen Panel (RPP) and COVID-19 tests.
According to the complaint filed in the US District Court for the Middle District of Florida, Hoobler allegedly agreed to provide her assistance under the condition that she received payment for COVID-19 tests on a per-test basis and combining it with RPP tests, whose Medicare reimbursement rates are four times higher than for COVID-19 tests.
Slamming the attempts at illegally profiting from the pandemic, Maria Chapa Lopez, US Attorney, Middle District of Florida said, "Fraud related to COVID-19 is particularly disturbing as it exploits a national crisis for personal gain." She added that the investigative agencies will be vigilant during the pandemic to ensure the health care system is not exploited and defrauded in its wake.