On Friday, January 6, 2023, three individuals named John Grisham, Rob Wilburn, and Richard Speights Jr., from Texas and Louisiana were charged with conspiracy fraud, swindling the United States. From paying and receiving health care kickbacks, approximately $107 million in false and fraudulent genetic testing claims were fraudulently submitted to Medicare.
Court filings revealed that John Grisham, 49, from Hickory Creek, Texas, Rob Wilburn, 51, from San Antonio Texas, and 52-year-old Richard Speights Jr. from Lake Charles, Louisiana, were allegedly charged for swindling at least $107 million in genetic testing claims to both Medicare and Medicare Advantage, along with other conspirators. The conspirators allegedly managed Trinity Clinical Laboratories LLC, a genetic testing laboratory in Lewisville, Texas.
From January 2018 to October 2019, Grisham, Wilburn, and Speights Jr. and fellow conspirators allegedly received Medicare beneficiaries’ DNA specimens and prescriptions for Trinity Clinical Laboratories to deceitfully bill Medicare and Medicare Advantage for genetic testing, in return for bribes kickbacks.
The defendants and co-conspirators reportedly used fictitious contracts for pretended marketing and other services to hide the nature of the kickback payments. Medicare is said to have compensated Trinity Clinical Laboratories $44 million over the same time period based on allegedly false claims made as a result of the defendants' payment and acceptance of kickbacks and bribes.
John Grisham, Rob Wilburn, and Richard Speights Jr. are all charged with a count of conspiracy to defraud the United States. Grisham and Wilburn are both charged with six counts each, while Speights Jr. is charged with two counts. If officially found guilty, they will be given 10 years in prison on each count of paying and receiving kickbacks and bribes, along with five years for the conspiracy count. A federal district court judge is to decide any sentence after taking into consideration the U.S. Sentencing Guidelines and other legal elements.
The statement was given by Justice Department’s Criminal Division's Assistant Attorney General Kenneth A. Polite, Jr., Northern District of Texas U.S. Attorney Leigha Simonton, U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Dallas Region Acting Special Agent in Charge Jason Meadows, FBI Dallas Field Office Acting Special Agent in Charge James Dwyer, Medicaid Fraud Control Unit of the Texas Office of the Attorney General (TX-MFCU) Chief William Marlowe, U.S. Postal Inspection Service (USPIS) Fort Worth Division Inspector in Charge Thomas Noyes, Internal Revenue Service Criminal Investigation (IRS-CI) Dallas Field Office Special Agent in Charge Christopher Altemus, and U.S. Department of Labor (DOL) Employee Benefits Security Administration Dallas Office Regional Director Deborah L. Perry.
The case, which was delivered as part of Operation Double Helix, is being investigated by the Health and Human Services Office of Inspector General (HHS-OIG), Federal Bureau of Investigation (FBI), Texas Medicaid Fraud Control Unit, U.S. Postal Inspection Service, and the U.S. Department of Labor. The case will be prosecuted by trial attorneys Carlos A. López and Lee Hirsch of the Criminal Division’s Fraud Section.
The Fraud Section oversees the Health Care Fraud Strike Force Program, which is how the Criminal Division combats health care fraud. Since March 2007, this operation, which consists of 15 strike groups operating in 24 federal districts, has filed charges against more than 4,200 defendants, totaling more than $19 billion against the Medicare program. Together with the Office of the Inspector General for the Department of Health and Human Services, the Centers for Medicare & Medicaid Services are also taking steps to hold providers accountable for their involvement in healthcare fraud schemes.
Operation Double Helix refers to when patients were reportedly coaxed into giving out their DNA for testing in an extensive genetic testing fraud scheme fueled by a big telemarketing system. Medical professionals, such as doctors and nurses involved in the case, were bribed to prescribe the testing with no patient communication or only via brief telephone conversations.