Genomic Health Agrees to $32.5 Million Settlement Over Alleged Medicare Billing Scheme

Genomic Health, Inc. (GHI) has agreed to a $32.5 million settlement to resolve allegations that it violated the False Claims Act by engaging in a nationwide scheme to improperly bill Medicare for certain laboratory tests used to diagnose and treat cancer patients.

GHI, a subsidiary of Exact Sciences Corporation, allegedly evaded Medicare’s 14-Day Rule governing billing for genomic laboratory tests, including its principal test, Oncotype DX®. The U.S. asserted that GHI manipulated the rule by seeking direct reimbursement for tests ordered within 14 days after a hospital discharge and encouraged the cancellation and reorder of tests to circumvent the time restriction. GHI also failed to send timely invoices to hospitals, violating the Anti-Kickback Statute, the DOJ claims.

The settlement arises from whistleblower actions, filed against GHI under the qui tam provisions of the False Claims Act. Under those provisions, private citizens can file an action on behalf of the United States and receive a portion of any recovery. This settlement sets aside $5,687,500 to be awarded to those that brought qui tam actions.

False Claims Act and Qui Tam Whistleblowers

Whistleblowers possessing firsthand knowledge of healthcare fraud play a pivotal role in exposing and combating fraud within the industry. Under the False Claims Act, these individuals can file qui tam actions, serving as private citizens filing lawsuits on behalf of the government. Such whistleblowers not only contribute to the detection and prosecution of fraudulent activities but also stand to receive financial rewards for their efforts. In recognition of their invaluable contribution to upholding the integrity of healthcare systems, whistleblowers may be awarded a portion of the recovered funds, providing both a safeguard against wrongdoing and a powerful incentive for individuals to step forward and disclose fraudulent practices that compromise the well-being of patients and the financial integrity of government programs.

 If you possess information about potential Medicare fraud and are considering taking action, The Kardell Law Group is here to support and guide you through the process of filing a qui tam suit under the False Claims Act. Our experienced attorneys specialize in representing whistleblowers, and your decision to come forward could not only help expose fraudulent practices but also lead to a financial recovery. Contact us today to confidentially discuss your knowledge of Medicare fraud, and let us work together to protect the integrity of healthcare systems and ensure that perpetrators are held accountable.