By: Christopher Parrella, Esq., CPC, CHC, CPCO Parrella Health Law, Boston, MA. A Health Care Provider Defense and Compliance Firm

The Government’s Message Is Clear: Your Billing Company Can Put You in the DOJ’s Crosshairs

A recent False Claims Act (FCA) case in the Southern District of Florida delivers a loud and unambiguous warning to revenue cycle companies: billing services are no longer passive support players in fraud investigations, they can be center stage defendants.

According to the U.S. Department of Justice (DOJ), AIMA Business and Medical Support, LLC, a third-party billing and consulting company, allegedly orchestrated and facilitated a Medicare fraud scheme worth more than $15 million. The DOJ alleges that AIMA helped a clinical laboratory submit claims for medically unnecessary genetic tests and using its billing knowledge and back-end operations in India to manipulate medical records and skirt compliance requirements.

What Did AIMA Allegedly Do?

The government alleges that between August 2018 and August 2019:

• AIMA knowingly billed Medicare for pharmacogenetic (PGx) and cancer genetic (CGx) tests that were not ordered by treating physicians and had no treatment purpose.
• The tests were instead marketed through call centers, collected before doctor consultations, and falsely documented to meet Medicare’s “medical necessity” requirements.
• AIMA allegedly advised its lab client (Selecta Laboratory) on how to manipulate documentation to avoid scrutiny such as ensuring that the date of the doctor’s order matched the DNA sample collection date.
• India-based staff with no medical background were allegedly authorized to guide physicians on how to order tests and to prepare the documentation used to justify billing.

What Makes This Case Alarming for Billing Agencies?

1. Scienter Allegations Are Deeply Rooted in Knowledge of Billing Rules The government emphasized that AIMA was not some bystander but rather was hired precisely because of its expertise in Medicare billing rules and Local Coverage Determinations (LCDs). That expertise, the DOJ claims, was weaponized to commit fraud.
2. Back-Office Behavior Can Create FCA Liability The Complaint alleges that billing staff based abroad, who lacked appropriate qualifications, advised U.S. doctors on clinical decisions tied to billing. This blurs the lines between billing support and clinical interference potentially triggering Anti-Kickback Statute and FCA exposure.
3. False Documentation Allegations The DOJ claims AIMA helped create or alter doctors’ notes, requisition forms, and supporting documentation to feign medical necessity. This conduct may fall under the FCA’s “causing the use of false records” prong, even if the billing company didn’t submit the claims themselves.

Practical Takeaways for Billing Companies and Their Health Care Clients

1. Your Compliance Program Is Now Your Defense Mechanism Billing agencies must maintain their own HIPAA, FCA, and CMS compliance programs especially when serving high-risk clients such as genetic testing labs, substance use disorder treatment providers, and telemedicine platforms.
2. Know When to Say No Compliance should include client intake risk scoring. Agencies must avoid servicing providers who request practices that would violate coverage policies, LCDs, or medical necessity rules.
3. Watch the Documentation Trail If your agency is generating or altering medical records, even indirectly, you’re potentially co-signing those records. If they’re false, you’re in the fraud crosshairs.
4. Remote Staffing Heightens the Risk Utilizing overseas employees for sensitive documentation, chart review, or interaction with providers must be carefully scrutinized for compliance. Medical necessity determinations and physician guidance should be handled by licensed professionals, not call center staff.

Billing Agencies: It’s Time to Reassess Your Risk Exposure

This case marks a clear shift in enforcement posture. The DOJ is actively seeking to hold billing vendors accountable under the False Claims Act especially when they play an active role in claims development, documentation, or scheme implementation. If you’re a billing company working in the lab, genetic testing, or telemedicine space, it’s time to take a hard look at your practices, client mix, and compliance infrastructure.

Need Help Assessing Your Risk?

If your billing operations support high-risk healthcare services and you’re unsure how to insulate yourself from liability, contact Parrella Health Law at 857-328-0382 or Chris directly at cparrella@parrellahealthlaw.com. We help both billing agencies and providers implement robust compliance frameworks and avoid DOJ scrutiny.