The DOJ announced that John Grisham, Rob Wilburn, and Richard Speights were charged with conspiracy to defraud the United States and to pay and receive health care kickbacks and bribes.  The Defendants, and their co-conspirators, allegedly submitted at least $107 million in cancer genetic (CGx) and pharmacogenomic (PGx) test claims to Medicare and Medicare Advantage in violation of the Anti-Kickback Statute.

According to court filings, from January 2018 to October 2019, the defendants owned and operated Trinity Clinical Laboratories LLC in Lewisville, Texas. Grisham served as the company’s chief executive officer, Wilburn served as the company’s chief financial officer, and Speights Jr. was a co-owner. Together with their co-conspirators, the three men allegedly acquired thousands of Medicare beneficiaries’ DNA specimens, along with their corresponding prescriptions, and used them to fraudulently bill Medicare and Medicare Advantage for genetic testing. CGx testing is used to predict an individual’s risk of developing cancers in the future but they are not diagnostic tests. As such, Medicare only covers CGx testing when a beneficiary has already had cancer and it is deemed necessary by their treating physician. PGx testing is used to help determine how effective certain medications will be based on genetic variations. Defendants allegedly created sophisticated contracts for marketing and other services to conceal the illegal kickbacks they paid and received in exchange for DNA specimens. Medicare reimbursed Trinity Clinical Laboratories approximately $44 million based on the fraudulent genetic testing claims. According to the indictment, the defendants distributed the foregoing payments amongst themselves.

Grisham and Wilburn are charged with six counts of paying and receiving health care kickbacks and bribes, and Speights Jr. is charged with two counts of paying and receiving health care kickbacks and bribes. All three men are charged with one count of conspiracy to defraud the United States, which carries a maximum sentence of 5 years. Each count of paying and receiving health care kickbacks and bribes carries a maximum sentence of 10 years. This matter is currently pending in the Northern District of Texas, Dallas Division.

The attorneys at Chilivis Grubman represent clients of all types and sizes in connection to False Claims Act litigation and health care fraud matters. If you need assistance with such a matter, please contact us today.