NEWARK, N.J. - A doctor based in Gainesville, Florida, was charged with conspiracy to commit health care fraud for ordering genetic tests for patients he never saw or treated, U.S. Attorney Craig Carpenito announced today.
Matthew S. Ellis, 53, of Gainesville, Florida, is charged by complaint with one count of conspiracy to commit health care fraud. Ellis made his initial appearance today before U.S. Magistrate Judge Mark Falk in Newark federal court and was released on $250,000 unsecured bond.
According to documents filed in this case and statements made in court:
Ellis served as the chief medical officer for Ark Laboratory Network LLC, a company that purported to operate a network of laboratories that facilitated genetic testing. Two conspirators who operated Ark, Edward Kostishion, 59, and Kacey Plaisance, 37, both of Florida, were each charged by complaint on Jan. 15, 2019, with one count of conspiracy to commit health care fraud.
In October 2018, Kostishion and Plaisance contacted a clinical laboratory in New Jersey and proposed sending the laboratory 10 DNA swabs for genetic tests in return for approximately 50 percent of the total Medicare payments the laboratory received as a result of the tests. Kostishion later sent 10 test orders to the laboratory that listed Ellis as the “Ordering Physician" and contained a certification from Ellis that the tests were medically reasonable and necessary. The test requests contained fraudulent information regarding medical histories and conditions, and falsely represented that Ellis provided the patients with information regarding genetic testing.
One of the test requests, relating to “Patient 1," indicated that Patient 1 had a personal history of breast cancer at age 44, a prerequisite for Medicare coverage of the particular test requested. However, on Nov. 29, 2018, Patient 1 confirmed to law enforcement officials that the information on the test request was false; Patient 1 never had cancer and never told anyone about having cancer. Patient 1 also stated that Patient 1 submitted to the DNA swab after seeing an advertisement on Facebook that offered a $100 gift card for people interested in genetic testing. Patient 1 stated that the DNA swab was not taken at a medical office, but rather in a “plain old office building" and that “some random guy" took the swab. Patient 1 confirmed never seeing or speaking to a treating physician about the genetic testing, and never saw or spoke to Ellis, the ordering physician listed on the test request.
Ellis practices medicine in Florida, but Patient 1 was located in Oklahoma. All 10 of the patients in the test requests were located in Oklahoma, Arizona, Tennessee, or Mississippi. None of the patients were located in Florida. Additional investigation revealed that Ellis was not licensed to practice medicine in Oklahoma.
The health care fraud count carries a maximum penalty of 10 years in prison and a maximum fine of $250,000 or twice the gross gain or loss from the offense.
U.S. Attorney Carpenito credited the U.S. Department of Health and Human Services, Office of Inspector General, under the direction of Special Agent in Charge Scott Lampert; and special agents of the U.S. Attorney’s Office for the District of New Jersey, with the investigation leading to today’s charges.
The government is represented by Assistant U.S. Attorney Bernard J. Cooney of the Health Care and Government Fraud Unit of the U.S. Attorney’s Office in Newark.
The charges and allegations against the defendants are merely accusations, and they are presumed innocent unless and until proven guilty.
Source: U.S. Department of Justice, Office of the United States Attorneys
