Laboratory Owners and Executives Charged in Health Care Kickback Scheme
A superseding indictment was unsealed today charging two Texas men and a Louisiana man for conspiracy to defraud the United States and to pay and receive health care kickbacks, resulting the submission of over $107 million in false and fraudulent genetic testing claims to Medicare.
According to court filings, John Grisham, 49, of Hickory Creek, Texas, Rob Wilburn, 51, of San Antonio, Texas, and Richard Speights Jr., 52, of Lake Charles, Louisiana, and their co-conspirators, were allegedly responsible for the submission of at least $107 million in genetic testing claims to Medicare and Medicare Advantage as the result of a sophisticated and nationwide health care kickback scheme.
The defendants allegedly owned and operated a genetic testing laboratory, Trinity Clinical Laboratories LLC, located in Lewisville, Texas. From January 2018 through October 2019, in exchange for kickbacks and bribes, Grisham, the chief executive officer, Wilburn, the chief financial officer, Speights Jr., a co-owner, and their co-conspirators, allegedly acquired thousands of Medicare beneficiaries’ DNA specimens and corresponding prescriptions that Trinity Clinical Laboratories used to fraudulently bill Medicare and Medicare Advantage for genetic testing. To conceal the nature of the kickback payments, the defendants and their co-conspirators allegedly utilized sham contracts for purported marketing and other services. During the same time frame, Medicare allegedly reimbursed Trinity Clinical Laboratories approximately $44 million based on the fraudulent claims submitted due to the defendants’ payment and receipt of kickbacks and bribes.
All three defendants are charged with one count of conspiracy to defraud the United States and to pay and receive kickbacks and bribes. Grisham and Wilburn are each charged with six counts, and Speights Jr. is charged with two counts of paying and receiving health care kickbacks and bribes. If convicted, the defendants face 10 years in prison on each count of paying and receiving health care kickbacks and bribes and five years in prison on the conspiracy count. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.
Assistant Attorney General Kenneth A. Polite, Jr. of the Justice Department’s Criminal Division; U.S. Attorney Leigha Simonton for the Northern District of Texas; Acting Special Agent in Charge Jason Meadows of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Dallas Region; Acting Special Agent in Charge James Dwyer of the FBI Dallas Field Office; Chief William Marlowe of the Medicaid Fraud Control Unit of the Texas Office of the Attorney General (TX-MFCU); Inspector in Charge Thomas Noyes of the U.S. Postal Inspection Service (USPIS) Fort Worth Division; Special Agent in Charge Christopher Altemus of the Internal Revenue Service Criminal Investigation (IRS-CI) Dallas Field Office; and Regional Director Deborah L. Perry of the U.S. Department of Labor (DOL) Employee Benefits Security Administration Dallas Office made the announcement.
The HHS-OIG, FBI, TX-MFCU, USPIS, IRS-CI, and DOL are investigating the case, which was brought as part of Operation Double Helix, a federal law enforcement action led by the Health Care Fraud Unit of the Criminal Division’s Fraud Section, in partnership with the U.S. Attorneys’ Offices for the Southern District of Florida, Middle District of Florida, Southern District of Georgia, Eastern District of Louisiana, Middle District of Louisiana, District of New Jersey, and Northern District of Texas.
Trial Attorneys Carlos A. López and Lee Hirsch of the Criminal Division’s Fraud Section are prosecuting the case.
The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, comprised of 15 strike forces operating in 24 federal districts, has charged more than 4,200 defendants who collectively have billed the Medicare program for more than $19 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at https://www.justice.gov/criminal-fraud/health-care-fraud-unit.
An indictment is merely an allegation. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.