New Orleans 男子参与医保基因检测诈骗：被判向 Medicare 赔付逾700万美元
美国路易斯安那州东区联邦检察官办公室宣布，现年55岁、来自 New Orleans 的 John M. Spivey 于10月13日被判向 Medicare 赔付逾700万美元，罪名是参与共谋实施医疗保健诈骗。联邦检察官 David I. Courcelle 公布了判决。
法庭文件显示，Spivey 与来自 Missouri 的50岁同案被告 Jamie P. McNamara 共谋，以不符合 Medicare 报销条件的癌症基因检测与心血管基因检测向 Medicare 收费：这些检测并无医疗必要性，且通过支付非法回扣与贿赂获取。McNamara 在 Spivey 的协助下经营多家实验室，通过电话营销人员与呼叫中心以强势营销手段劝说 Medicare 受益人接受基因检测，再由所谓的远程医疗医生签署检测医嘱，而这些医生既不是受益人的主治医生，也未曾为受益人看诊或在检测后随访。记录显示，2018年11月至2020年7月，这些实验室向 Medicare 提交逾1.74亿美元的虚假欺诈性 claims，并获得逾5,500万美元赔付。两人均已认罪。
联邦地区法官 Darrel J. Papillion 判令 Spivey 支付7,002,410.26美元赔偿，与 McNamara 承担连带责任；Spivey 同时被判五年缓刑，其中第一年在居家监禁中执行。McNamara 此前已被判监禁10年并赔付1.74亿美元，另被没收约700万美元资金与三辆车。案件由美国卫生与公众服务部督察长办公室与联邦调查局调查。
New Orleans Man Ordered to Pay Over $7 Million in Restitution for Medicare Genetic Testing Fraud Conspiracy
The U.S. Attorney's Office for the Eastern District of Louisiana announced that John M. Spivey, 55, of New Orleans, was ordered on October 13 to pay over $7 million in restitution for his role in a conspiracy to commit health care fraud. U.S. Attorney David I. Courcelle made the announcement.
According to court documents, Spivey conspired with co-defendant Jamie P. McNamara, 50, of Missouri, to defraud Medicare by billing for cancer genetic testing and cardiovascular genetic testing that was ineligible for reimbursement because it was not medically necessary and was procured through illegal kickbacks and bribes. McNamara, assisted by Spivey, operated several laboratories that obtained doctors' orders from telemarketers and call centers using aggressive campaigns to induce Medicare beneficiaries to agree to testing; the orders were signed by purported telemedicine doctors who were not the beneficiaries' treating physicians and performed no consultations or follow-up. From November 2018 through July 2020, the laboratories submitted over $174 million in false and fraudulent claims to Medicare and received over $55 million in reimbursements. Both men pleaded guilty.
U.S. District Judge Darrel J. Papillion ordered Spivey to pay $7,002,410.26 in restitution to Medicare, jointly and severally with McNamara, and sentenced Spivey to five years of probation, the first year in home confinement. McNamara was previously sentenced to 10 years in prison and $174 million in restitution, and was ordered to forfeit approximately $7 million and three vehicles. The case was investigated by the U.S. Department of Health and Human Services Office of Inspector General and the FBI.
发布：GSM·美国（发布链接）
图片来源：图：位于 New Orleans 的 Hale Boggs 联邦大楼与美国法院大楼。照片：Ktkvtsh 摄，CC BY 4.0，经 Wikimedia Commons。 / The Hale Boggs Federal Building and United States Courthouse in New Orleans. Photo by Ktkvtsh, CC BY 4.0, via Wikimedia Commons.
GSM Global · 本篇英文版 English edition of this story
