Medicare Genetic Testing Fraud: Lab Schemes Explained

How a Medicare Genetic Testing Fraud Conspiracy Led to $174 Million in False Claims

Two defendants in the Eastern District of Louisiana pleaded guilty to a Medicare genetic testing fraud conspiracy in which laboratories submitted over $174 million in false and fraudulent claims to Medicare for cancer genetic testing and cardiovascular genetic testing and received over $55 million in reimbursements. The scheme ran from November 2018 through July 2020. On October 13, 2026, U.S. District Judge Darrel J. Papillion sentenced Jamie P. McNamara, age 50, of Missouri, to 10 years in prison and $174 million in restitution, and also ordered forfeiture of approximately $7 million in funds and three vehicles. Co-defendant John M. Spivey, age 55, of New Orleans, was sentenced to five years of probation — the first year served in home confinement — and ordered to pay $7,002,410.26 in restitution to Medicare, jointly and severally with McNamara. Every False Claims Act matter is different; results depend on the specific facts of each case, and no similar outcome is implied.

The testing at the center of this Medicare genetic testing fraud was ineligible for reimbursement on two grounds: it was not medically necessary, and it was procured through the payment of illegal kickbacks and bribes. The scale of the restitution order — $174 million — reflects the financial exposure that the False Claims Act can generate when fraudulent claims are submitted in volume across multiple laboratories.

How the Scheme Worked: Telemarketing, Telemedicine, and Lab Billing

According to court documents, the fraud operated through a three-stage pipeline: aggressive patient recruitment by telemarketers, bulk order-signing by telemedicine physicians who had no real relationship with the patients, and laboratory billing to Medicare for tests that were ineligible for reimbursement. Each stage of the pipeline was essential to the scheme, and each stage involved participants who could face legal exposure.

Step 1 — Telemarketing-Driven Patient Recruitment

Call centers and telemarketers ran aggressive campaigns to induce Medicare beneficiaries to agree to receive genetic testing. Patients were not referred by their own treating physicians; instead, they were solicited directly by marketers whose goal was to generate test orders that could be billed to Medicare.

Step 2 — Telemedicine Doctors Signing Orders Without Real Consultations

Orders for genetic testing were signed by purported telemedicine doctors who were neither the beneficiaries’ treating physicians, nor performed actual consultations with the beneficiaries, nor followed up with the beneficiaries after testing. According to court documents in the Spivey/McNamara matter, these physicians signed orders in bulk, without the kind of medical relationship that Medicare requires.

Step 3 — Laboratories Submitting Claims to Medicare

McNamara operated several laboratories that submitted the fraudulent claims. Spivey assisted McNamara in running the operation. Because the testing was procured through illegal kickbacks and bribes and lacked medical necessity, every claim submitted was ineligible for reimbursement — yet the laboratories collected over $55 million before the scheme was prosecuted.

A Structurally Similar Case Confirms a Pattern of Enforcement

A separate case decided days later shows the same architecture. On October 23, 2026, Christopher Harwood, 44, of Fort Lauderdale, Florida, owner and operator of a telemedicine company called TelevisitMD, was sentenced to 20 years in prison for organizing and leading a $46.2 million Medicare fraud conspiracy. Medicare paid $17.9 million based on those claims. Harwood was ordered to pay $17,942,402 in restitution to Medicare and $10,431,463 in forfeiture. Every False Claims Act matter is different; results depend on the specific facts of each case, and no similar outcome is implied.

According to court documents, Harwood and his co-conspirators targeted Medicare patients through aggressive telemarketing campaigns, inducing them to accept orthotic braces and genetic tests they did not need. Harwood paid doctors to approve orders for orthotic braces and genetic tests; those doctors did not have real medical relationships with the Medicare patients and often signed orders without any meaningful interaction with them. Harwood then sold the signed doctors’ orders to laboratories, durable medical equipment supply companies, and marketers who were part of the scheme.

The structural overlap between the two cases is notable: telemarketing to patients, telemedicine doctors signing orders without real relationships, and laboratories billing Medicare. Taken together, these enforcement actions suggest that the Department of Justice and HHS-OIG are actively targeting the full chain of participants — lab operators, telemedicine company owners, marketers, and call center operators — not only the most visible actor in any given scheme.

Medicare Genetic Testing Fraud: Red Flags for People Working Inside These Operations

Employees at genetic testing laboratories, telemedicine platforms, call centers, or marketing companies that feed orders to labs may recognize elements of these schemes in their own workplaces. The following red flags appear directly in the court records from both cases described above.

• Telemarketing-driven patient recruitment — patients are solicited by call centers rather than referred by their own treating physicians.
• Physicians signing genetic test orders in bulk with no prior patient relationship and no follow-up after results are returned.
• Cancer genetic testing or cardiovascular genetic testing billed to Medicare without documented medical necessity.
• Kickback arrangements — payments flowing between laboratories, marketers, call centers, or telemedicine companies in exchange for test orders.
• High-volume order flow from a single telemedicine platform or marketing entity to a laboratory.

Individuals who recognize these patterns in their workplace may have grounds to file a qui tam lawsuit under the False Claims Act. Our attorneys who handle laboratory fraud cases can help evaluate whether a situation warrants further review.

If practices like these look familiar from your own workplace, you can discuss what you have seen with a Price Armstrong attorney confidentially and at no cost. Call (888) 670-9542 or use the secure evaluation form below.

Frequently Asked Questions About Medicare Genetic Testing Fraud and Whistleblower Rights

Who can file a qui tam lawsuit under the False Claims Act?

Under 31 U.S.C. § 3730, a person may bring a civil action for a violation of section 3729 for the person and for the United States Government. This means an individual with inside knowledge of a Medicare genetic testing fraud scheme — whether they work at a laboratory, a telemedicine company, a call center, or a marketing firm — may potentially serve as a relator. The complaint is filed under seal while the government investigates.

What share of a recovery might a whistleblower receive?

Under 31 U.S.C. § 3730(d), if the government proceeds with the action, the relator may receive at least 15 percent but not more than 25 percent of the proceeds of the action or settlement, subject to the provisions of that subsection. If the government declines to intervene and the relator proceeds, the relator may receive an amount that the court decides is reasonable, but in no case more than 30 percent. The statute also provides that the relator shall receive an amount for reasonable expenses, plus reasonable attorneys’ fees and costs. No assurance of any particular outcome can be given; the amount a relator may recover depends on the specific facts and circumstances of each case.

Why does timing matter for a potential whistleblower?

Under 31 U.S.C. § 3730(b)(5), when a person brings an action under this subsection, no person other than the Government may intervene or bring a related action based on the facts underlying the pending action. This first-to-file rule means that only the first relator to file on a particular fraud scheme may share in the recovery. Someone with knowledge of an ongoing Medicare genetic testing scheme may have a time-sensitive interest in consulting with experienced qui tam attorneys. The False Claims Act also provides, under 31 U.S.C. § 3729, for liability including treble damages plus civil penalties per false claim — which is why the financial exposure in cases like the McNamara matter can reach the scale reflected in a $174 million restitution order. Every False Claims Act matter is different; results depend on the specific facts of each case, and no similar outcome is implied.