Doctor Chase Genetic Testing: The Test Was Chosen Before the Doctor Was Asked

Doctor chase genetic testing schemes use marketers to identify a Medicare beneficiary’s existing physician and pressure that office to approve testing selected by nonmedical callers. The sales operation has already decided that the patient qualifies. The treating doctor enters the process when somebody needs an order. For the employee handling authorizations, the question is who chose the test before the physician was asked to approve it.

How Marketing Paperwork Becomes a Physician Order

A genetic test order signed through the doctor chase process starts with a marketing decision that callers bring back to the patient’s own physician. In its account of the criminal trial involving the owner of Axis Professional Labs and Kingdom Health Laboratory, the Department of Justice described marketers hiring other companies to solicit Medicare beneficiaries. Those companies obtained the identities of the beneficiaries’ primary-care physicians and pressured them to approve genetic testing.

The callers claimed that the patients had already qualified during telephone calls with nonmedical personnel. That is the central reversal. The people selling the test supplied the supposed qualification, then sought the treating physician’s approval. The physician’s name could make the finished order look clinical while concealing how the decision began.

The physician’s chart and the marketer’s paperwork can tell very different stories about the same patient. Under Medicare’s ordering and documentation rule, the treating practitioner documents why the test is needed, while the billing entity keeps the information it receives and records showing its claim reflects that information. A caller’s conclusion that the patient qualifies starts somewhere else: the effort to sell the test.

The payment arrangement helps explain the interest in obtaining that approval. For covered laboratory fee-schedule services where the laboratory accepts Medicare’s payment as payment in full, the beneficiary owes no deductible or coinsurance. The physician makes the clinical decision, the laboratory earns the payment, and Medicare pays the bill. A marketer who can influence the order can influence which laboratory gets the business.

Doctor Chase and Telemedicine Orders Are Different

Doctor chase pursues the beneficiary’s existing physician. In the telemedicine schemes, the marketing chain supplies a clinician to sign. The difference matters to anyone who sees a familiar physician’s name on an order and assumes the request began in that physician’s office.

The criminal charges announced in Operation Double Helix alleged that cancer genetic-testing laboratories paid kickbacks for beneficiary referrals through medical professionals working with telemedicine companies. According to those charges, doctors prescribed testing without any patient interaction or after only a brief telephone conversation with patients they had never met or seen. The alleged chain bought access to beneficiaries and to the person who could authorize testing.

Prepopulated paperwork makes the distinction especially concrete. In its account of a physician assistant’s criminal conviction, the Justice Department described electronic signatures on prepopulated genetic-testing orders, paid at $12 and later $15 per purported consultation. The form and the signature were separate parts of the transaction. The clinician was paid for the step that completed the order.

A laboratory employee may see only the completed form, with the earlier calls and payment arrangement held elsewhere.

Do Doctors Get Kickbacks for Ordering Tests?

Yes. The Operation Double Helix charges alleged payments to doctors to prescribe genetic testing. The Axis and Kingdom criminal-trial account describes a different payment relationship: the laboratory owner concealed per-sample kickbacks through contracts and invoices for marketing hours.

A treating doctor pressured by a caller is in a different position from a doctor paid to sign orders.

What the Order, Specimen and Invoice Reveal

The order, specimen and invoice connect the medical authorization to the laboratory’s revenue and the marketer’s compensation. A signed requisition shows what testing was requested. The specimen and testing records connect that request to the work performed or billed. The invoice shows what the laboratory paid to obtain the business.

In the Axis and Kingdom criminal case, the government’s trial account described sham contracts and invoices that purported to charge for marketing hours. The owner worked backward from the agreed per-sample kickback to create the invoice. Hours appeared on the bill because samples determined the amount owed.

An invoice framed as time spent on marketing can conceal a price for each sample delivered. The commercial agreement tells a different story from the description on the invoice. For someone in accounts payable, the sample count may explain a charge that the stated hours cannot.

The same comparison reaches the laboratory floor. The sample identifies the patient material connected to an order. The test record shows what the laboratory did with it. The claim shows what the laboratory asked Medicare to pay. We connect those records with the referral arrangement to understand what the marketer was selling and what the laboratory was buying.

When one laboratory sends a specimen to another for testing, the claim and test record can name different businesses. Following the chased order through both connects the authorization to the work and the company billing Medicare.

What Axis and Kingdom Billed and What Medicare Paid

The Axis and Kingdom criminal-trial account puts the scale at approximately $328 million billed and approximately $54 million paid. A jury convicted the owner. Medicare money paid for tests that nonmedical callers had decided patients qualified for, before their physicians were asked. Taxpayers funded the business of turning sales calls into health care claims.

The Pattern Across Genetic Testing Cases

A separate whistleblower complaint concerning LabSolutions and CLIO alleges that the process of making patients qualify could happen inside physician practices. Medical assistants working for Integrated and HSS allegedly reviewed patient lists, questioned patients using prepared scripts and steered referrals to the laboratories. The complaint describes what the questions were designed to accomplish:

The questions, the whistleblower alleged, were built to reach a set answer. Staff also allegedly received instructions to place false qualifying criteria on order forms. One example was listing a mood disorder because a patient took several medications, even when the patient did not meet the appropriate criteria. The alleged paperwork supplied a medical explanation designed to support reimbursement.

The same complaint alleged that LabSolutions and CLIO paid a set amount for each referral. That links the screening questions, the order-form criteria and the laboratory destination to the compensation. Staff were allegedly taught to produce the qualification that made the referral possible.

This complaint concerns staff in physician offices, while the Axis and Kingdom trial account describes callers pressuring treating physicians. The shared pattern is control over the information presented for approval. Someone outside the treating clinician’s independent decision supplies the reason to test, and the laboratory receives the resulting referral.

A diagnosis field is therefore part of the story, alongside the signature. The HHS Office of Inspector General’s laboratory compliance guidance addresses invented diagnostic information and computer programs that insert diagnosis codes without information from the ordering practitioner. It also calls for requisition forms that reflect an independent medical-necessity decision for each test the laboratory will bill.

A Genetic-Test Order Has to Lead to Care

For Medicare diagnostic testing, the treating practitioner’s role includes using the result to manage the patient’s specific medical problem. That connects the order to the care it is supposed to support. It also explains why an approval obtained after a marketing call deserves attention beyond the signature itself.

Who supplied the information, and what supported it, is the consequential difference.

The result supplies another connection to care. The Operation Double Helix charges alleged that results often never reached beneficiaries or were worthless to their actual doctors. The authorization chain served the sale. According to the charges, it often failed to serve the patient’s care.

For a laboratory or medical-office insider, the important knowledge may sit at just one of these handoffs: who drafted the request, who supplied the diagnosis, who approved it, or what triggered the referral payment. We bring that knowledge together with the order, testing and billing records to assess a civil healthcare whistleblower case. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

When You Know How the Order Was Obtained

If you handled the calls, orders or payments behind genetic testing, speak with our whistleblower experts about how the physician’s approval was obtained. We work beside you to build the case around the clinical paperwork and the business that produced it, and bring in genetic-testing fraud whistleblower lawyers who understand laboratory billing and referral payments. You know the part of the process the finished requisition leaves out.