U.S. Attorney Duane A. Evans announced that John Spivey, 53, of New Orleans, pled guilty on July 30 to a conspiracy to commit healthcare fraud.
According to court documents, Spivey conspired with his codefendant, Jamie McNamara, 48, of Missouri, to defraud Medicare by billing for cancer genetic testing and cardiovascular genetic testing that was ineligible for Medicare reimbursement.
The testing was ineligible because it was not medically necessary and was procured through the payment of illegal kickbacks and bribes.
McNamara, with the assistance of Spivey, operated several laboratories that obtained doctors’ orders for genetic testing from telemarketers and call centres that used aggressive telemarketing campaigns to induce Medicare beneficiaries to agree to receive genetic testing.
Orders for genetic testing were signed by purported telemedicine doctors who were neither the beneficiaries’ treating physicians nor performed the consultations with the beneficiaries, or even followed up with the beneficiaries post-testing.
According to court records, from November 2018 through July 2020, the laboratories operated by McNamara submitted over $174 million in false and fraudulent claims to Medicare for genetic testing and received over $55 million in reimbursements. McNamara is set for trial in February of 2025.
United States District Judge Darrel J. Papillion is scheduled to sentence Spivey on April 15, 2025. At sentencing, Spivey faces up to ten years in prison, followed by up to three years of supervised release following any term of imprisonment, as well as a fine of up to $250,000 or twice the gross gain to any defendant or loss to any person.
Spivey also faces payment of a $100 mandatory special assessment fee per count.
