US Medicare Fraud Oversight Highlights $547 Million Genetic Test Scheme

Federal audits of Medicare Advantage plans this spring uncovered widespread improper diagnosis coding. Reviewers found that 81‑91% of sampled high‑risk codes lacked supporting medical records, prompting a major insurer to agree to a $117.7 million settlement with the government.

Separately, the Department of Justice has charged laboratory owner Khalid A. Satary with a scheme that billed Medicare more than $547 million for medically unnecessary genetic tests between 2016 and 2019. Prosecutors allege the operation used telemarketing, patient recruiters and kick‑back payments to telemedicine doctors to generate orders for expensive cancer‑related tests. Satary, previously a fugitive, has been arrested and returned to U.S. custody pending trial.

Both cases illustrate systemic vulnerabilities in the U.S. Medicare system and have spurred calls for stronger oversight of provider billing practices.