Somerset County Man Indicted for Role in $1 Million Medicare Fraud that Deceived Seniors into Unnecessary DNA Tests
Defendant Used Purported Non-Profit to Convince Seniors to Submit to Unnecessary Testing; Paid Healthcare Providers to Falsely Claim Tests Were Necessary
NEWARK, N.J. –A Somerset County, New Jersey, man was indicted by a federal grand jury today for using the purported non-profit The Good Samaritans of America to defraud the Medicare Program of more than $1 million by convincing hundreds of senior citizens to submit to unnecessary genetic testing, U.S. Attorney Craig Carpenito announced.
Seth Rehfuss, 43, of Somerset, New Jersey, is charged by indictment with conspiracy to commit health care fraud and conspiracy to wrongfully access individually identifiable health information and to pay illegal remunerations to health care professionals.
According to documents filed in the case and statements made in court:
From July 2014 through December 2015, Rehfuss, conspirator Sheila Kahl of Point Pleasant, New Jersey, and others allegedly used The Good Samaritans of America and offers of “free ice cream” to gain access to low-income senior housing complexes. Rehfuss and other members of the scheme claimed that The Good Samaritans of America was a “trusted non-profit” that assisted senior citizens in navigating federal benefit programs. In reality, The Good Samaritans of America was a front to present information about genetic testing.
In order to convince senior citizens to submit to genetic testing, Rehfuss used fear-based tactics during the presentations, including suggesting the senior citizens would be vulnerable to heart attacks, stroke, cancer and suicide if they did not have the genetic testing. In addition, Rehfuss claimed that the genetic testing allowed for “personalized medicine.”
As part of the scheme, Seth Rehfuss and others frequently took DNA swabs in the community rooms where the presentations took place or made arrangements to visit the senior citizen’s apartment on another day to take the DNA swab. Regardless of the timing or location of the swabbing, the DNA swab was collected without the involvement of any healthcare provider and without any determination by a healthcare provider that such testing was medically necessary or appropriate.
To get the tests authorized, Rehfuss used advertisements on Craigslist to recruit healthcare providers for the scheme. After entering into contractual relationships with The Good Samaritans of America, the healthcare providers received requisition forms that often included a patient’s personal information, Medicare information, medication lists and diagnosis codes.
The healthcare providers were paid thousands of dollars per month by Rehfuss and Kahl to sign their names to requisition forms authorizing testing for patients they never examined and were in no way involved in the patients’ care or treatment. Rehfuss and Kahl used fraudulent email accounts to access the individually identifiable health information of the senior citizens, specifically the results of the DNA analysis.
Rehfuss, Kahl and others caused the Medicare program to pay more than $1 million to two clinical laboratories. Rehfuss obtained more than $100,000 and distributed commissions to Kahl of tens of thousands of dollars.
Rehfuss and others were actively working towards expanding the scheme outside of New Jersey into other states, including: Georgia, Delaware, Virginia, Maryland, Pennsylvania, South Carolina, Michigan, Mississippi, Florida, Tennessee and Arizona.
The healthcare fraud conspiracy charge carries a maximum potential penalty of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. The conspiracy charge carries a maximum penalty of five years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. Sheila Kahl previously pleaded guilty and is awaiting sentencing.
U.S. Attorney Carpenito credited special agents of the U.S. Department of Health and Human Services – Office of the Inspector General, under the direction of Special Agent in Charge Scott J. Lampert, along with special agents of the U.S. Attorney’s Office for the District of New Jersey, with the investigation leading to today’s indictment.
The charges and allegations in the indictment are merely accusations, and the defendant is presumed innocent unless and until proven guilty.
The government is represented by Danielle Alfonzo Walsman, Chief of the U.S. Attorney’s Office’s Public Protection Unit in Newark.