Ocenture and Carelumina: Direct Patient Solicitation and Genetic-Test Kickbacks

Ocenture LLC and its subsidiary Carelumina LLC agreed to pay $3 million to resolve allegations that they paid and received kickbacks for genetic-testing samples, causing false Medicare claims. The case reached the business arrangements behind the tests: who recruited the beneficiaries, who paid for the medical justification and who shared in Medicare’s payment.

Ocenture is a privately held company headquartered in Jacksonville, Florida. The Justice Department announced the civil settlement on December 15, 2022.

How the Alleged Genetic-Testing Scheme Worked

The government alleged that Ocenture obtained genetic-testing samples from Medicare beneficiaries, paid physicians to falsely attest that the tests were medically necessary, and arranged laboratory processing and Medicare reimbursement. Part of that reimbursement allegedly went back to Ocenture. In the government’s account, the company stood on both sides of the money flow: paying for the physician’s attestation and receiving money after the laboratory’s claim.

Direct Solicitation and Other Marketers

Ocenture allegedly solicited samples directly from Medicare beneficiaries and through other marketers.

A person handling beneficiary outreach may know what the patient was offered and what the marketer was asked to deliver. That knowledge gives us a way to compare the sales pitch with the medical reason later attached to the sample. In this case, the government alleged that Ocenture connected solicitation to the purchase of that medical justification.

Do Doctors Get Kickbacks for Ordering Tests?

In the Ocenture case, the government alleged that physicians received payments to falsely attest that genetic testing was medically necessary. Ocenture allegedly paid for the clinical justification that allowed the samples to proceed through the laboratory and into Medicare billing.

A judgment about a patient’s need for testing was allegedly something the marketing business could purchase. Taxpayers paid for the tests that followed those allegedly false medical justifications.

A Share of Medicare Reimbursement for Ocenture

Ocenture allegedly arranged for clinical laboratories to process the tests and receive Medicare reimbursement, with a portion paid to Ocenture. The laboratory claim was the point where the alleged arrangement drew money from Medicare. The return payment connected that money to the business recruiting the samples.

Why the Order and the Claim Tell Different Stories

Under Medicare’s documentation rule, the ordering practitioner keeps the medical reason for the test in the patient’s record. The laboratory keeps what the practitioner sent and records showing that the claim matches that information.

A laboratory employee might see the attestation without seeing the arrangement that produced it. A marketer might know how the physician became involved without seeing the eventual claim. The Ocenture allegation joins those views: the company allegedly arranged both the false attestation and the testing that Medicare reimbursed.

Laboratory compliance work has focused on that connection between test selection and its written justification for decades. The 1997 Laboratory Medicine article Model Plan Helps Laboratories Fight Fraud described federal recommendations for uniform requisition forms with space for a physician to document the medical necessity of each test. It also described physician acknowledgment for customized test profiles.

The requisition does more than tell a laboratory which test to run. It connects that selection to the clinician’s reason for ordering it. The article’s focus on individual tests and physician acknowledgment explains why a medical-necessity attestation carries weight inside the testing business, and why paying for a false one attacks that connection.

In its clinical laboratory compliance guidance, the Office of Inspector General acknowledged that laboratories cannot treat patients or make medical-necessity determinations. An insider who knows how an order was produced may therefore know something the test result itself cannot show.

The Marketers Who Brought the Case

The whistleblower claims came from two health care marketers Ocenture approached to participate in the alleged arrangement. They brought a qui tam case under the False Claims Act, and the civil settlement resolved claims from that case.

A marketer’s account can make an arrangement understandable from its commercial side: what work was proposed, how the samples were to move, and how the participants expected to be paid. We work with that account alongside the clinical and billing records, so the case explains the relationship between the business proposal and the government claim.

Other Genetic-Testing Cases Show the Pressure on Referrals

The whistleblower complaint involving LabSolutions alleged that scripted screening questions generated testing referrals for which laboratories paid fixed fees. The government’s complaint against Progenity alleged that excessive blood-draw fees, meals and happy hours, and routine cost-sharing reductions or waivers induced test orders.

What Evidence Is Needed to Prove Fraud?

For an arrangement like the one alleged against Ocenture, the evidence needs to connect beneficiary solicitation, physician attestations, laboratory claims and the payments among the participants. Our whistleblower experts examine those connections with the insider who knows how the business worked.

Building a healthcare fraud case means explaining how those parts fit together, including what the people arranging the transactions knew. We work with your knowledge of the business to make that connection.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know How the Samples Became Business

If you saw how a genetic-testing company recruited patients, obtained physician attestations or paid for referrals, speak to one of our Whistleblower Experts about the arrangement. We turn your knowledge of the business into a case with genetic-testing fraud whistleblower lawyers who understand the links between marketing, medical necessity and Medicare billing. We stay with you as your partners throughout the case.