(The Center Square) – A federal grand jury in Colorado recently indicted seven people for defrauding Medicare and Colorado Medicaid.
The indicted people include: Ronald King, 51, of Bangor, Maine; Victor Roiter, 55, of Sunny Isles Beach, Florida; Tina Wellman, 51, of Mayfield, New York; Adam Shorr, 55, of Dunedin, Florida; Robert O’Sullivan, 55, of Lake Sherwood, California; Bradley Edson, 66, of Mesa, Arizona; and John Gautereaux, 59, of Temecula, California, according to the United States Attorney’s Office for the District of Colorado.
The defendants were allegedly involved in many corporate entities together, including as owners of Tesis Labs, LLC. It’s a parent company that owned and operated genetic testing labs, like Claro Scientific Laboratories and 303 Diagnostics LLC, based in Colorado.
King, Roiter, Wellman, and Shorr allegedly conspired to defraud Medicare and Colorado Medicaid through several means, one of which was paying bribes and kickbacks to marketing companies for fraudulent and medically unnecessary genetic testing. These tests led to $40 million in fraudulent Medicare and Colorado Medicaid payments to the laboratories.
All seven defendants allegedly partook in a conspiracy to offer and pay illegal bribes and kickbacks connected to healthcare programs like Medicare, Colorado Medicaid, and private health insurance plans.
The defendants agreed to pay kickbacks and bribes to entities and people identified as “marketers” who solicited patients, like Medicare recipients, to partake in unneeded genetic testing and to get doctors’ signatures on testing order forms for these people. Some kickback recipients used call centers to target these Medicare recipients.
The indictment also alleges that King, Roiter, and Wellman worked together to launder the proceeds of the conspiracies.
Defendants King, Wellman, Shorr, O’Sullivan, Edson, and Gautereaux made initial court appearances before Magistrate Judge Susan Prose from August 26 to September 5, 2024, in Denver, Colorado.
Medicare and Medicaid reportedly made over $100 billion in improper payments last year for the wrong amount or ones that never should have happened. The U.S. Government Accountability Office has made several recommendations to save Medicare $141 billion in fraud over 10 years.
For example, the GAO recommended that the Centers for Medicare & Medicaid Services enhance Medicaid provider screening and monitoring, adopt a risk-based approach for Medicare revalidations, seek authority for cost-effective prepayment reviews, address Medicare payment disparities across service locations, assess the quality of telehealth services, make sure Medicaid demonstrations cut federal spending, and improve coordination with state auditors to tackle fraud.
