Paid Healthcare Providers to Falsely Claim Tests Were Necessary, Defrauding Medicare of More than $1 million
NEWARK, N.J. – A Somerset, New Jersey, man was arrested this morning and charged with using the non-profit The Good Samaritans of America to defraud the Medicare program by convincing hundreds of senior citizens to submit to unnecessary genetic testing, U.S. Attorney Paul J. Fishman announced.
Seth Rehfuss, 41, was charged by criminal complaint with one count of healthcare fraud. He is scheduled to appear later today before U.S. Magistrate Judge Joseph A. Dickson in Newark federal court.
According to the complaint:
From July 2014 and continuing through the present, Seth Rehfuss and others used The Good Samaritans of America 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. Rehfuss used advertisements for free ice cream to ensure attendance at the presentations.
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, defendant 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.
In order 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 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. As a result, Rehfuss caused the Medicare program to pay more than $1 million to two clinical laboratories, from which defendant Rehfuss obtained commissions of tens of thousands of dollars.
The investigation revealed that 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 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.
U.S. Attorney Fishman 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 investigators from the United States Attorney’s Office for the District of New Jersey and the U.S. Marshals Service Asset Forfeiture Program, with the investigation leading to the charges.
The pending charges against Rehfuss are merely allegations, and he is considered innocent unless and until proven guilty.
The government is represented by Assistant U.S. Attorney Danielle M. Corcione of the U.S. Attorney’s Office Health Care and Government Fraud Unit.
U.S. Attorney Paul J. Fishman reorganized the health care fraud practice at the New Jersey U.S. Attorney’s Office shortly after taking office, including creating a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since 2010, the office has recovered more than $640 million in health care fraud and government fraud settlements, judgments, fines, restitution and forfeiture under the False Claims Act, the Food, Drug, and Cosmetic Act and other statutes.
Defense counsel: TBD