A Flower Mound doctor is among 35 people charged in a health care fraud scheme involving fraudulent genetic cancer testing.
Daniel R. Canchola, 49, is suspected of submitted false claims to Medicare for cancer screenings genetic tests, or CGx, that were not necessary or prescribed.
Canchola was charged Friday with one count of conspiracy to commit health care fraud and wire fraud and three counts of health care fraud.
According to the Department of Justice, Canchola received illegal kickbacks and bribes for the cancer genetic test orders he signed.
Canchola's attorney could not be reached for comment.
The indictment stated Canchola did that without seeing or communicating with the patients and without determining the needs for the test.
“Daniel Canchola was not treating the beneficiaries for which he signed doctors’ orders for CGx testing for cancer or symptoms of cancer, and he did not use the test results in the treatment of the beneficiaries,” the indictment stated.
The indictment stated Canchola created invoices to track the number of beneficiaries for whom he signed off for the testing and requested $30 per order.
The beneficiaries for whom Canchola signed the doctors’ orders were targeted at health fairs and through telemarketing, the indictment stated, and they were encouraged to submit for testing regardless of medical necessity.
It stated Canchola “caused the submission of over $69 million in false and fraudulent claims to Medicare” from around May 2018 to March 2019. Medicare, as a result, made payments of $13 million to two laboratories that conducted CGX testing.
The charges come on the heels of a federal investigation that led to one of the biggest health care fraud schemes ever charged, according to a release from the Department of Justice. In all, the 35 defendants that are associated with telemedicine companies and cancer genetic testing laboratories are suspected of fraudulently billing Medicare $2.1 billion.
“Healthcare fraud and related illegal kickbacks and bribes impact the entire nation," said Assistant Director Terry Wade of the FBI’s Criminal Investigative Division. “Fraudulently using genetic testing laboratories for unnecessary tests erodes the confidence of patients and costs taxpayers millions of dollars. These investigations revealed some medical professionals placing their greed before the needs of the patients and communities they serve. Today's law enforcement actions reinforce that the FBI, along with its partners, will continue to pursue and stop this type of illegal activity.”
The investigation spans five federal districts.
The Centers for Medicare & Medicaid Services, Center for Program Integrity, announced it took administrative action against cancer genetic testing companies and medical professionals who submitted more than $1.7 billion in claims to Medicare, the release stated.
Friday’s charges wrapped up a month-long investigation led by the Criminal Division’s Health Care Fraud Unit. The release stated that effort led to more than 380 people being charged after allegedly billing federal health care programs for more than $3 billion, as well as allegedly prescribing or dispensing approximately 50 million controlled substance pills across the country, including Texas.
There are 105 defendants charged with opioid-related offenses and 178 defendants who are medical professionals, the release stated.
“These defendants allegedly duped Medicare beneficiaries into signing up for unnecessary genetic tests, costing Medicare billions of dollars,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division. “Together with our law enforcement partners, the Department will continue to protect the public and prosecute those who steal our taxpayer dollars.”