Genexe and Immerge: Swabs First, Physician Orders Later

In the Genexe Immerge settlement, Genexe, Immerge and two executives agreed to pay $6 million over allegations of unnecessary genetic testing and kickbacks. The business allegedly supplied laboratories with both the samples to test and the physician orders needed to bill Medicare, then took a share of the money Medicare paid.

Genexe, which did business as Genexe Health, marketed genetic and pharmacogenetic profiling. It marketed itself as handling everything from sample collection to laboratory processing. Its parent, Immerge, promoted outsourced sales and marketing for energy, telecom, wireless and solar businesses. Genetic testing was another of its marketing businesses.

Both companies had their principal address in Greenwood Village, Colorado. The Justice Department announced the settlement on April 23, 2025, covering alleged conduct from July 2018 through December 2019. At the time of the announcement, neither company was still operating.

The settling parties were the companies and their chief executive and chief operating officers, both of whom held ownership interests in the businesses.

From Community Swab to Laboratory Claim

Genexe allegedly recruited Medicare beneficiaries for genetic testing before obtaining the physician orders for their samples. Its campaigns offered the testing purportedly at no cost to patients. The government described a business that could start in a shopping mall or church and end with a laboratory billing Medicare.

The Justice Department alleged that Genexe hired and paid independent contractors to act as genetic screening technicians. Most had no medical training. They collected DNA specimens, usually cheek swabs, at stores, shopping malls, healthcare fairs, churches, retirement centers and skilled nursing facilities.

In that account, the contractors also collected beneficiaries’ health information on requisition forms and labeled the specimens. They shipped the packaged samples to Immerge in Colorado. Genexe then obtained physician orders before sending the samples to laboratories for testing. Genexe’s agreements with telemedicine companies and laboratories allegedly supplied the route from a collected swab to a physician’s order.

The government alleged that once an order was obtained, Genexe sent the specimen to a laboratory. That laboratory tested it and billed Medicare, or arranged for another laboratory to perform the testing and bill. When Medicare paid the laboratory, Genexe received a portion of the reimbursement.

The government alleged that Genexe connected those steps through paid referrals and purchased orders. The marketing business’s role continued well beyond finding someone willing to take a test.

Why the Physician Order Mattered

The physician order was supposed to connect a genetic test to the beneficiary’s treatment. In explaining the case, the Justice Department said Medicare Part B coverage required an order from a physician or qualified practitioner treating a specific medical problem and using the results to manage that problem.

The tests at issue served different purposes. Cancer genetic testing looks for inherited changes associated with a predisposition to cancer. Pharmacogenomic testing concerns how a person’s genes affect their response to medications. Those purposes make the clinical question central: what problem was the test meant to help the practitioner manage?

A cheek swab supplies the sample. A requisition typically identifies the patient, the specimen and the referring provider, and includes confirmation that the test is medically necessary. In the government’s account, Genexe had the sample in hand and then arranged the order. The allegation was that the resulting tests were medically unnecessary and the orders were bought through kickbacks.

For this business, we examine what happened between the collection of the specimen and the signed statement that testing was needed, and what happened to the results afterward.

The government alleged payments in both directions: payments to contractors for beneficiary referrals and to medical or telemedicine providers for prescriptions, followed by payments from laboratories for the completed swabs and prescriptions. The signature was part of what the marketing enterprise allegedly supplied.

The Payments Behind the Free Test

Genexe’s alleged compensation depended on laboratory testing paid by Medicare. The Justice Department alleged that laboratory reimbursement regularly exceeded $6,000 per test, while Genexe initially received about $800 per swab, later receiving $1,000 to $2,000 depending on the type of test.

The test was free in the sales pitch. Taxpayers paid for the unnecessary testing the government alleged. In that account, the marketer’s revenue came from Medicare money paid to the laboratory after the sample and order reached it. A completed swab could therefore have a commercial value to the marketer before anyone had used a test result to care for the patient.

A 2024 Rutgers University Law Review paper, Plausible Cause: Connecting the FCA and AKS in the Context of Health Care Fraud, discusses the features the Office of Inspector General has associated with greater potential for abuse in sales arrangements. They include percentage-based compensation, contact with beneficiaries and ordering physicians, and marketing items or services billed separately to a federal health care program.

That discussion helps explain what to examine in this case’s payment chain. Who recruited the beneficiary? Who could produce the order? What event earned the payment? The Justice Department alleged that Genexe’s laboratory revenue was a portion of Medicare receipts. The contractor agreements, order arrangements and laboratory payments connect the sales incentive to the tests the government funded.

What Is the Reward for a Medicare Fraud Whistleblower?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. In the Genexe and Immerge resolution, the Justice Department announced that four whistleblowers would collectively receive approximately $1.3 million.

Whistleblowers brought False Claims Act cases against the businesses. The government joined a whistleblower case to settle it.

For a recruiter or coordinator, the significance is that this case reached the marketing side of the business. The laboratory submitted the Medicare claim, but the government also pursued the enterprise it alleged had supplied the beneficiary, swab and purchased order.

What Evidence Is Needed to Prove Fraud?

For a specimen-and-order business, the evidence needs to tie each swab to the patient’s clinical assessment, the signed order, the Medicare claim and the payment back to the marketer. We work through those connections with the insider who knows how the business operated.

Different employees may understand different parts. A recruiter may know what beneficiaries were told and what information they supplied. A telemedicine coordinator may know whether a signed order followed an actual patient assessment or only a completed form. A billing or accounting employee may know how the laboratory’s receipts became the marketer’s payment. Our work is to connect that operational knowledge to the claim and the people directing the arrangement.

When a Portal Turns an Approval Into an Order

In a separate Delaware civil case involving MySpecialistMD, the government alleged that portal approvals generated orders and medical-necessity paperwork before the physician spoke with beneficiaries.

You Know How the Orders Were Obtained

If you worked with genetic-test recruiters, sample routing or payments for physician orders, speak to one of our whistleblower experts about how the orders were bought. We build your strongest genetic-testing whistleblower case with you around the connections between recruitment, medical necessity and laboratory money, and bring in healthcare fraud whistleblower lawyers who know genetic-testing kickback cases. We stay beside you through the case, with your knowledge of the business at its center.