Georgia Man Sentenced for $7.2M Medicare Genetic Testing Kickback Scheme

A Closer Look at the Latest Genetic Testing Fraud Case and What It Signals for Insurers

Federal prosecutors recently secured a significant conviction in an expansive genetic testing fraud scheme, and the details offer important lessons for insurers navigating an increasingly complex healthcare landscape. The case of Patrick C. Moore Jr. of Peachtree City, Georgia, sheds light on how sophisticated referral networks and aggressive kickback arrangements continue to pressure federal programs and private payers alike.

Moore was sentenced to 46 months in prison and ordered to repay more than $7.2 million after admitting he orchestrated a kickback scheme tied to medically unnecessary genetic tests billed to Medicare. Prosecutors say he directed a web of recruiters who persuaded Medicare beneficiaries to undergo genetic tests that were unnecessary, improperly delivered, or not eligible for reimbursement. In return, Moore received roughly $4.3 million in kickbacks for funneling beneficiary information, DNA samples, and forged physician orders to labs. Those labs billed Medicare around $24 million and were paid $7.2 million.

“This case shows how fraud can infiltrate critical healthcare systems and exploit people who rely on them.”
HHS Office of Inspector General spokesperson

To hide these payments, Moore fabricated invoices that suggested routine work hours rather than referral fees. This concealment violated the Anti-Kickback Statute, a cornerstone of federal efforts to protect program integrity. His guilty plea included conspiracy to defraud the United States and engaging in illegal healthcare kickbacks.

Why This Case Matters for the Insurance Industry

The investigation, led jointly by the HHS Office of Inspector General and the FBI, forms part of the long-running Health Care Fraud Strike Force Program. Since 2007, the program has charged thousands of defendants with defrauding federal healthcare programs and private insurers. It continues to expand its footprint across federal districts.

The Moore prosecution underscores a few key realities shaping today’s insurance environment:

• Fraudulent genetic testing schemes are growing more sophisticated, making detection and prevention more challenging.

• Referral arrangements involving recruiters and labs remain a high-risk area for audits and enforcement.

• Coordinated investigations are increasing, signaling stronger cross-agency scrutiny of both ordering providers and diagnostic laboratories.

• Insurers are likely to face greater regulatory and enforcement expectations related to oversight of high-cost diagnostics.

Understanding the Broader Impact

Genetic testing remains a rapidly expanding sector, but with growth comes more vulnerability. Fraud rings often target seniors, exploit confusion about Medicare coverage rules, and use forged medical documentation to justify claims. These schemes not only drain federal funds but also distort claim patterns that insurers rely on to manage risk.

“Aggressive enforcement is a necessary response to schemes that erode trust in our healthcare system.”
Justice Department official

For insurers, the effects are twofold. First, fraudulent claims place upward pressure on costs and can skew actuarial assumptions. Second, heightened federal activity suggests insurers may face more expectations around early detection and reporting of suspicious billing patterns.

Looking Ahead

As enforcement intensifies, stakeholders should expect continued focus on genetic testing laboratories, third-party marketing entities, and referral relationships. The Moore case serves as a reminder that even seemingly routine administrative invoices can mask illicit financial arrangements.

Federal agencies have made clear that protecting Medicare and other health programs remains a top priority. Insurers that invest in stronger analytics, clearer provider education, and proactive fraud mitigation strategies will be best positioned to navigate this evolving enforcement landscape.

The message from regulators is clear: accountability is increasing, and schemes that undermine the integrity of healthcare payments will be met with substantial penalties.