Lab testing and Medicare billing fraud

What the fraud has looked like in public cases

On October 20, 2026, the Justice Department said a federal jury in Maryland convicted Patrick Britton-Harr of health care fraud and money laundering. According to the release, he offered COVID-19 tests to nursing homes in 2020 and then billed Medicare for separate respiratory pathogen panel tests, falsely claiming treating physicians had ordered them. The release says evidence at trial showed billing for tests that were never performed, including for residents who had already died, and that his company billed Medicare $18.7 million, of which Medicare paid more than $7.2 million. ¹ Source 1

The same day, the Justice Department announced an indictment in Illinois. It alleges that a laboratory co-owner created fake negative results for at least 380,000 COVID-19 PCR tests the laboratory never performed, so it could bill the HRSA Uninsured Program, which covered testing for people without health insurance. The release says the laboratory submitted about $66.2 million in claims and HRSA paid about $44.1 million. An indictment is an allegation, not a conviction. ² Source 2

HHS-OIG describes a genetic testing scheme in which recruiters persuade a Medicare beneficiary to take a genetic test, a doctor is paid a kickback to order it, and the laboratory bills Medicare and shares the payment with the recruiter. OIG says a September 2019 takedown resulted in charges against 35 individuals for alleged schemes involving $2.1 billion in losses. ³ Source 3

OIG’s consumer alert says genetic testing fraud occurs when Medicare is billed for a test that was not medically necessary or was not ordered by the beneficiary’s treating physician. It says scammers offer “free” screenings or cheek swabs through telemarketing calls, booths at public events, health fairs, and door-to-door visits, to obtain Medicare information for identity theft or fraudulent billing. ⁴ Source 4

The billing rules these cases turn on

Under Medicare’s regulation at 42 CFR 410.32, diagnostic laboratory tests generally must be ordered by the physician who is treating the beneficiary and who uses the results to manage the beneficiary’s specific medical problem. The regulation says tests not ordered by the treating physician are not reasonable and necessary. ⁵ Source 5

A CMS fact sheet on lab documentation says the entity billing the claim must keep documentation of the order, and that the medical record should show both the intent to order the test and its medical necessity. It says most improper lab service payments found in its error-rate reviews come from insufficient documentation. The fact sheet treats that as a documentation error; it does not call it fraud. ⁶ Source 6

HHS-OIG’s 2014 Special Fraud Alert on laboratory payments to referring physicians says the Anti-Kickback Statute makes it a crime to knowingly and willfully pay or receive anything of value to induce referrals of items or services paid by a federal health care program. It says claims resulting from a kickback are not payable by Medicare and may be false claims under the False Claims Act, even if the tests were medically necessary. ⁷ Source 7

OIG’s summary of the fraud and abuse laws lists clinical laboratory services among the “designated health services” covered by the physician self-referral law, known as the Stark law, which restricts referrals to entities in which the physician or an immediate family member has a financial relationship, unless an exception applies. ⁸ Source 8

Which published programs may apply

The Justice Department’s October 20, 2026 reward materials cover federal health care offenses and related crimes involving health care benefit programs, and fraud on programs administered by the Department of Health and Human Services. The early payment described there is $10,000 to $30,000, in the Department’s discretion, after criminal charges are unsealed. Whether a particular tip qualifies is the Department’s decision, not this site’s. ⁹ Source 9 ¹⁰ Source 10 ¹¹ Source 11

The False Claims Act is the civil statute the Justice Department uses for knowingly false claims for federal money, and a private person may file a qui tam suit under seal. If the government proceeds, the relator’s statutory share is at least 15% and not more than 25% of the proceeds; if it does not, the share is 25% to 30%. Other limits apply. ¹² Source 12 ¹³ Source 13

HHS-OIG runs a hotline that accepts complaints about fraud, waste, and abuse in Medicare, Medicaid, and other HHS programs. The hotline page reviewed for this guide does not describe a reward, and it says not every submission results in an investigation. ¹⁴ Source 14

Where to report

Use America.gov/fraud, the federal portal named in the October 2026 announcement. The Justice Department’s Civil Division also describes reporting to an inspector general or the FBI, or filing a sealed qui tam complaint. This site does not accept the report and does not give legal advice. ⁹ Source 9 ¹⁵ Source 15 ¹⁶ Source 16