The East Point resident’s insurer Anthem declined to pay the bill because it considers the test to be medically unproven and unnecessary for her treatment. Brown, 50, works two jobs and cannot afford to pay such a steep bill on her wages.
“Whether they ordered the test by mistake or to make money, my real issue is my doctor failed to look out for my best interests,” said Brown. She suffers from bipolar disorder, which can cause extreme mood swings.
Brown’s case highlights the rise of a problem in medicine where labs perform expensive genetic tests that patients don’t need, want or understand, according to reporting by Channel 2 Action News and The Atlanta Journal-Constitution.
While genetic tests can be powerful tools, medical experts debate their usefulness in the treatment of psychiatric and other diseases. Some manufacturers overstate their tests’ abilities. If insurance doesn’t cover them or give prior approval, patients can be left with the bill.
And in what prosecutors say is a disturbing trend, labs across the country have come under investigation for performing genetic tests for fraudulent purposes.
The owner of LabSolutions, which billed Brown for the test, was indicted recently on felony fraud, money laundering and other charges in a U.S. Department of Justice probe that officials called one of the largest health care schemes ever charged.
LabSolutions owner Minal Patel used kickbacks and bribes to get patients to undergo cancer genetic testing regardless of whether they needed it, using telemedicine doctors to approve the tests, prosecutors in Operation Double Helix said. Medicare and Medicare Advantage plans paid the company some $154 million. Brown's doctor was not part of the alleged scheme.
Patel’s 2019 Land Rover Range Rover, a 2018 Ferrari 488 Spider, a house, a Buckhead condo and commercial property are being seized in the case, according to a federal indictment filed Sept. 24. The Atlanta resident is out on $1 million bond.
Steve Sadow, lead attorney in Patel’s federal case, said the accusations “appear to be based on false or misleading statements” by people cooperating with federal investigators to get lighter sentences in their own cases.
“Genetic testing by LabSolutions was always done based on a doctor’s written request,” Sadow said. “At trial, we intend to show that the conduct of LabSolutions and Minal Patel was based on the advice of lawyers and that Mr. Patel had no intent to violate the law.”
A LabSolutions spokesman declined to discuss Brown’s case.
“As a general matter, all lab testing by LabSolutions is performed from a written order from a health care practitioner and in accordance with applicable guidelines,” a spokesman said in a written statement.
A Sept. 12 letter from a LabSolutions billing manager to Brown states that the company withdrew her bill. It was sent after questions from Channel 2 and the AJC.
Utility of genetic tests debated
Brown’s psychiatrist, Dr. Eddie Beal, stopped using LabSolutions and will offer genetic testing from another lab, a representative said, adding in an email to reporters that “mental health patients sometimes misreport information to gain an audience.”
Genetic testing is “an incredibly useful new technology that helps doctors and patients choose the best course of treatment for mental illness,” Beal said in a written statement.
Yet top experts maintain there is still much debate over these tests’ effectiveness in mental health treatment, said Dr. James Potash, director of Johns Hopkins Medicine’s Department of Psychiatry and Behavioral Sciences.
“Even among people who are at the cutting edge of the field there is not complete agreement on how useful or not useful these tests are at the moment,” Potash said.
Most research on genetic testing in psychiatry has focused on depression, and more needs to be done, said Potash, who has studied genetics and psychiatry for more than two decades. Data on the effectiveness of the field’s best-studied test is mixed.
The Food and Drug Administration urges patients to use caution with genetic tests.
"Changing drug treatment based on the results from such a genetic test could lead to inappropriate treatment decisions and potentially serious health consequences for the patient," it said in an Oct. 2018 public message.
‘I’m being used’
Brown received her test during a routine checkup to refill her medications, she said. After her statement from Anthem arrived, she asked her doctor, Beal, for an explanation during her next appointment and demanded her records via certified mail. But she did not receive either from him, she said.
Former LabSolutions clinical laboratory scientist Cheryl Thomas said Brown’s records should have raised flags at the testing facility. On the test’s requisition form where Brown’s signature belongs is a handwritten notation that said her signature was on file.
This indicates Brown did not sign it, said Thomas, who reviewed the form for Channel 2 and the AJC.
“The patient always has to sign each and every time they get testing so they are aware and they are authorizing the test,” Thomas said. She was let go in the rounds of layoffs that took place after the FBI raided LabSolutions’ west Midtown Atlanta office in August.
Brown did not receive medical records about her test until June, after she requested them through Anthem, she said.
“I think I’m being used and abused,” Brown said. “This is against what any doctor should be doing to any patient.”
Channel 2’s and the AJC’s reporting has prompted the Georgia Department of Insurance to investigate Brown’s case, an agency spokesperson confirmed.
Brown still worries that she will be on the hook for thousands of dollars in genetic testing charges. The Sept. 12 letter where LabSolutions states it withdrew its insurance claim maintained that she consented to testing. It also states the test took place Jan. 1, when doctors offices are closed.
Brown no longer sees Dr. Beal.
“He is a mental health doctor and he has caused me mental stress,” Brown said.
What to do if you suspect improper billing
Contact the provider for an explanation. Discuss and verify the date of service, service rendered and the cost. They may have made a mistake they can correct.
Follow up in writing and maintain documentation.
File a dispute with your insurance company. A number to report fraud should be on your Explanation of Benefits. If you are on Medicare, call 1-800-MEDICARE.
File a complaint with the Georgia Department of Insurance at 800-656-2298.
Sources: Georgia Department of Insurance, AARP