U.S. Files False Claims Act Complaint Over Medicare Genetic Test Billing

The U.S. government has filed a complaint under the False Claims Act against AIMA Business and Medical Support, LLC (AIMA), a medical billing and compliance service provider, for allegedly submitting false Medicare claims related to medically unnecessary genetic laboratory tests. AIMA, registered in Florida with a CEO based in the UK and employees in India, provided billing services for Selecta Laboratory, a Miami-based diagnostic lab. From August 2018 to August 2019, AIMA billed Medicare Part B approximately $15.2 million for genetic tests that were allegedly not medically necessary and not ordered by a treating physician, contravening Medicare coverage requirements.

Medicare coverage mandates that diagnostic tests, including genetic tests, be ordered by a treating physician and be reasonable and necessary for a beneficiary's diagnosis or treatment. The claim is that these tests did not meet such criteria, resulting in improper Medicare payments to Selecta Laboratory and corresponding payments from Selecta to AIMA for billing services. This case highlights the government’s ongoing focus on combating healthcare fraud, with the False Claims Act serving as a critical enforcement tool.

The U.S. Department of Justice and Health and Human Services Office of Inspector General are actively investigating and prosecuting this matter, emphasizing the importance of compliance and accurate billing in Medicare-related services. The Department encourages reporting of suspected healthcare fraud, waste, and abuse through official channels. No determination of liability has been made at this stage, and the complaint remains allegations pending further legal proceedings.