The Pitfalls of Pharmacogenetics (PGX) Testing 

The Pitfalls of Pharmacogenetics (PGX) Testing

What is Pharmacogenetics (PGX) Testing?

It is a particular Pharmacogenomic Research Network in which researchers examine the genetic and genetic contributions to drug response. PGX is an important opportunity to offer to patients the ability to choose the right drug, to deliver it at the right time, and to reduce side effects.

We are able to recognize the DNA sequence disparities for all of the genes that encode proteins for transporting drugs, targeting for drugs, or metabolizing drugs. In fact, PGX testing shows how a patient’s individual genetics will respond to medication.

This page is designed to assist you in conducting a thorough defense that best serves the interest of you and the justice system. 

We have here at Bell P.C also known as the Healthcare Fraud Group is a network of experienced legal professionals and attorneys who work collaboratively to defend clients across the United States. 

Personalized medicine used to be considered a thing of the future, but the future is here. Current uses for PGC testing include predicting a patient’s response to medications and the prescription of effective medicines for chronic pain. We are all made very differently genetically, and these differences influence how we respond to medication. 

 

What Is Pharmacogenetics (PGX) Testing Fraud?

Pharmacogenetics testing fraud is a kind of healthcare fraud that happens when entities or individuals improperly bill healthcare programs for PGX tests. 

Medicare only covers PGX tests for patients who have already been identified with a disorder or illness. Another common scenario is when labs provide inappropriate incentives to physicians for ordering federal PGX test samples.

Recently the federal government broke up a Medicare fraud scheme that involved selling genetic tests to seniors that they did not require them.

The selling point was “Don’t you want to know if your genetics predispose you to something like cancer?” The scammers informed seniors that all they needed was their information in order to order the tests.

 

The issues for providers under investigation are similarly complex, and the liability potentially quite severe. Going forward, we will provide sound guidance and advice to everyone in these complex situations. We are designed to anticipate and deal with potential pitfalls and problems for our clients during the health care fraud investigation and prosecution processes.

Medicare will have records indicating that it paid for genetic testing. Therefore, you may be denied future DNA testing. Furthermore, medicare information may be in the hands of somebody able to resell it for the same purpose in another scheme.

 

What are the Penalties? 

Pharmacogenetics testing fraud possibly violates the False Claims Act (31 U.S.C. § 3729 et seq.), the Anti-Kickback Statute (42 U.S.C. § 1320a-7b), and the healthcare fraud statute (18 U.S.C. § 1347), as well as other specific state healthcare laws. Violators may face criminal penalties, civil penalties, or both. At their discretion, prosecutors may pursue penalties under any or all of the statutes mentioned above. Civil penalties include exclusion from federal healthcare programs, treble damages, civil monetary penalties of $21,562 per violation, non-payment of future claims, and attorney fees. Criminal penalties include a maximum of 10 years in federal prison for each violation. Additionally, state penalties may involve loss of professional licenses and disciplinary hearings.

 

Pharmacogenetics testing fraud

This is a target of multiple federal agencies such as the Enforcement Action Team (HEAT) and Health Care Fraud Prevention, a joint effort of the Department of Justice and the Department of Health and Human Services that is designed to prevent Medicare fraud. Health care fraud investigations must be thoroughly examined in order to result in a prosecutable case. If you are a victim or you are under investigation, do not hesitate to give us a call 888-402-4054

 

To speak with a member of our defense team about your specific case in confidence, or for more information about our Medicare fraud defense practice, you can request a free initial case evaluation online or call 888-402-4054.