Florida Laboratory Owner Pleads Guilty to $52M Medicare Fraud Scheme Involving Genetic Tests

A Florida man pleaded guilty on Jan. 15 for his role in a scheme to defraud Medicare by submitting over $52 million in false and fraudulent claims for genetic testing that Medicare beneficiaries did not need and that were based on prescriptions purchased through illegal kickbacks and bribes.

According to court documents, Sean Alterman, 38, of Lake Worth, Florida, owned and operated two laboratories, Live Beyond Medical MGMT, LLC and Dynix Diagnostics LLC, through which he purchased doctors' orders for expensive genetic testing from patient recruiters. The patient recruiters ran deceptive telemarketing campaigns that targeted Medicare beneficiaries and persuaded them to agree to take the tests to justify the fraudulent billing.

As part of the scheme, the patient recruiters used a tactic known as "doctor chasing" - faxing physicians false and misleading requests for prescriptions designed to trick them into signing off on tests their patients did not need. The faxes and accompanying materials falsely stated, among other things, that the prescription requests were made on behalf a mutual patient. But they were generated by call centers that deceived the Medicare beneficiaries to agree to the tests without being examined or treated by physicians for the diseases underlying the tests.

Alterman's laboratories billed approximately $52 million to Medicare for the false and fraudulent claims, of which Medicare paid approximately $36 million. Alterman made roughly $5.5 million from the scheme, much of which he received through shell companies he owned called Shivv LLC and Shank LLC. As part of his plea agreement, Alterman agreed to forfeit his Lake Worth estate and a 2022 Rolls Royce Ghost purchased with money traceable to the scheme:

Alterman pleaded guilty to conspiracy to commit health care fraud and conspiracy to offer and pay kickbacks. He is scheduled to be sentenced on April 16 and faces a maximum penalty of 15 years in prison. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Assistant Attorney General A. Tysen Duva of the Justice Department's Criminal Division; Assistant Special Agent in Charge Chris Caldwell of the FBI; and Acting Deputy Inspector General for Investigations Scott J. Lampert of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) made the announcement.

The FBI and HHS-OIG are investigating the case.

Trial Attorneys Reginald Cuyler Jr. and Aisha Schafer Hylton of the Justice Department's Fraud Section are prosecuting the case. Assistant U.S. Attorney Nadya Cheatham for the Southern District of Florida is handling asset forfeiture.

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, currently comprised of nine strike forces operating in 27 federal districts, has charged more than 5,800 defendants who collectively have billed federal health care programs and private insurers more than $30 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, 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.