Deeper Than the Headlines: How Pre-Populated Forms Fueled a $24M Genetic Testing Fraud Scheme

In this month’s Deeper Than the Headlines, CJ Wolf breaks down a federal fraud case involving a physician who pled guilty to submitting false claims related to genetic testing. The doctor, a co-owner and advisor to a diagnostic lab in Georgia, conspired with others to generate medically unnecessary genetic test orders in exchange for kickbacks. 

What makes this case especially important for compliance professionals is not just the fraud itself — it’s how it was executed. According to court documents, the lab designed its order forms with pre-populated diagnosis codes and “check-the-box” panels that guided providers toward selections that made the tests appear medically necessary for reimbursement. These design choices allegedly helped drive more than $24 million in fraudulent claims, with Medicare paying out approximately $4 million before the scheme was uncovered. 

This case is a critical reminder that compliance risks aren’t limited to bad actors; they also hide in workflows, templates, and poorly designed processes. When forms do the thinking for providers, compliance failures follow. And as CJ notes, the concepts aren’t new — history just keeps repeating itself.