RediDoc: Genetic Testing Without a Treating Relationship

RediDoc genetic testing fraud involved a Lexington physician who, according to his criminal plea agreement, took payments to order unnecessary tests without a physician-patient relationship. He did not use the results in treatment. For a laboratory or telehealth insider, that is the connection worth examining: a company paid for orders, a physician supplied them, and the testing had no place in that physician’s care of the patient.

RediDoc Paid for Each Beneficiary

According to the physician’s criminal plea agreement, telemedicine company RediDoc paid him an average of $20 per beneficiary to provide telehealth services and order medically unnecessary equipment, topical creams and genetic testing. The Justice Department’s account of his plea agreement places the arrangement between March 2018 and April 2019.

The physician was a nephrologist practicing in Lexington, Kentucky. He worked for telemedicine companies that arranged for doctors to prescribe equipment, creams and testing for Medicare beneficiaries. Under the RediDoc agreement described in his plea, he received a kickback for each beneficiary even though he had no physician-patient relationship with them.

For someone reviewing compensation, the unit of payment matters. The agreement priced each beneficiary, so the payment records belong beside that beneficiary’s orders and clinical record.

Equipment, Creams and Genetic Tests in the Same Arrangement

The RediDoc agreement covered a mixed stream of medical orders. Genetic testing was one part of it, alongside medical equipment and topical creams. A laboratory employee seeing only the testing requisitions would be looking at one part of a broader arrangement.

In its account of the criminal case, the Justice Department reported that the physician received $261,054 in kickbacks from RediDoc for unnecessary equipment and services ordered for more than seven thousand Medicare beneficiaries. Medicare paid $14,150,765 for the medically unnecessary items across that mixed-service arrangement.

A small payment bought the physician’s orders. Taxpayers paid the much larger Medicare bill. A review limited to laboratory claims would leave the equipment and cream orders out of view.

Why the Treating Relationship Matters

A diagnostic laboratory order is supposed to come from the clinician treating the beneficiary and using the result to manage a specific medical problem. Medicare’s diagnostic-test ordering rule connects those activities. It ties the order to a patient’s care, rather than treating a doctor’s name on a form as the whole clinical decision.

The laboratory and the ordering practice also hold different parts of the story. The clinician maintains the medical-necessity documentation in the patient’s record. The laboratory submitting the claim keeps what it receives from the clinician and documentation showing that the claim accurately reflects that information.

The 2018 Journal of Health Care Compliance article Clinical Laboratory Compliance Issues explains why that division matters. Laboratories frequently perform tests requested by unrelated physicians, who may hold the only records demonstrating that a test was ordered and medically necessary. The article also describes the need for the test ordered, the test performed and the test billed to match.

In his plea, the RediDoc physician acknowledged that he lacked the treating relationship that the order was supposed to reflect.

When the Order Is the Doctor’s Only Role

In the physician’s plea, failure to use the results was a separate reason the orders were unnecessary.

Clinical Laboratory Compliance Issues reads the treating-physician requirement as a distinction between a clinician caring for the patient and one whose sole involvement was ordering laboratory tests.

The same article points to the physician’s documented intent that a test be performed. Together, the order, clinical notes and handling of results let us examine who made the testing decision and what medical purpose it served.

Paid Genetic-Test Orders Beyond RediDoc

The North Carolina physician assistant’s paid genetic-test orders offer a parallel: according to the Justice Department’s account of his criminal conviction, he was paid per purported consultation to sign prepopulated orders, while RediDoc paid per beneficiary.

What Evidence Is Needed to Prove Fraud?

For a paid-order arrangement like this one, the useful evidence connects compensation and orders to the clinical record, test results and Medicare payments. We examine those connections with the insider who knows how the business worked.

A telehealth employee may know how beneficiary assignments became physician payments. Someone in a laboratory may see where requisitions originated, what testing they requested and where results were sent. A person working with the physician’s records may know whether those results ever entered a treatment decision. Those are different views of the same transaction, and the RediDoc plea shows why each matters.

Our work is to connect what you saw inside the healthcare business with what the order and payment records show. An agreement priced by beneficiary, the resulting orders and the clinical record can tell a much fuller story together than any one file does alone.

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.

You Know How the Orders Were Bought

If you worked with RediDoc orders or a similar stream of paid genetic-test requisitions, speak to our whistleblower experts about how the orders were bought. We build your strongest health care whistleblower case with you and bring in healthcare fraud whistleblower lawyers who understand laboratory ordering and kickback arrangements. We stay beside you through the case.