North Texas Medical Labs Accused of Scamming Medicare to the Tune of $300 Million

The scheme was simple enough.

The labs would pay Dr. Eduardo Canova, Dr. Jose Maldonado and nurse practitioner Keith Wichinski. Then the medical professionals would order an unneeded laboratory test from one of the labs. Later, they'd bill the cost of the test to Medicare and other federal healthcare programs.

Founders of Unified Laboratory Services, Spectrum Diagnostic Laboratory and a slew of other medical testing companies in North Texas used this process to pull in more than $300 million from federal healthcare programs by billing for fraudulent tests.

The medical professionals also made off with a fair sum in bribes, court documents allege.

Dr. Maldonado collected more than $400,000 in kickbacks for billing over $4 million worth of lab tests, and Dr. Canova got $300,000 for more than $12 million in fraudulent tests.

The founders of several labs, alongside several of the doctors and nurses they allegedly bribed, were indicted on federal fraud charges in the Northern District of Texas on yesterday. Marketing professionals were also amongst the 10 people indicted, according to a press release.

“Anti-kickback laws are designed to ensure that financial considerations do not cloud physicians’ judgement,” U.S. Attorney Chad Meacham said in the statement. "The Justice Department is determined to prosecute those flouting our nation’s healthcare fraud laws. Patients – and taxpayers – deserve rigorous enforcement."

This wasn’t the only scheme the labs were reportedly running. Marketers acting on their behalf would carry out the deals between the labs and the doctors, court documents say. These payouts were used for various expenses, from subsidizing staff salaries in the doctor’s offices to covering portions of their office leases.

Doctors that billed more tests made more money in payouts from the labs, and those that didn’t order enough were threatened. In one case, when a medical office failed to order enough tests to satisfy the lab they had been working with, the lab said they would be cutting off payments unless they started ordering more. The office began sending 20 to 30 test referrals a day immediately after the threat.

Spectrum Diagnostic Laboratory and Unified Laboratory Services owners developed another layer of fraud that allowed them to both refer tests and bill Medicare all under one roof. Physicians who agreed to participate in the scheme were offered ownership stakes in both labs, allowing them to order tests and receive payouts under the auspices of a single company.

To maintain their ownership positions at the labs, physicians had to meet a quota of ordered tests.

“Illegal kickback schemes corrupt the healthcare system. They cause billions of dollars in losses each year, generate business for dishonest service providers and erode trust in our health care system,” said Dallas FBI Special Agent in Charge Matthew DeSarno. "The FBI will continue to work with our law enforcement partners to expose fraud and protect the public from illegal schemes."