By Pat Anson, Editor
A genetic testing company in southern California has been linked to a nationwide crackdown on healthcare fraud that resulted in criminal charges being filed against hundreds of doctors, nurses and medical professionals.
Among the defendants are three individuals affiliated with Physicians Primary Care of Jeffersonville, Indiana, who are accused of unlawfully dispensing oxycodone, hydrocodone and other opioid medications to patients without a legitimate medical need.
The charges also allege that Jeffrey Campbell, MD, and nurse practitioners Mark Dyer and Dawn Antle "caused Proove Bioscience, Inc., a genetic lab company, to falsely and fraudulently bill various health care programs for genetic tests administered to Physicians Primary Care patients that were not medically necessary and never interpreted."
Proove Biosciences is not formally charged in the grand jury indictment, which was unsealed yesterday in the U.S. District Court of Kentucky in Louisville. In an emailed statement to PNN, Proove's founder and CEO said the company cooperated with authorities and terminated its contract with Dr. Campbell when it first learned of the investigation in 2014.
"Since then, Proove has cooperated with both the FBI and US Attorney’s office on this case," said Brian Meshkin. "With regards to tests being 'medically necessary', Proove received written and signed determinations of medical necessity supporting the tests ordered and billed to insurance carriers just like every other laboratory which requires such a determination on a test requisition form. Thus Proove operated appropriately and consistent with usual and customary practices."
As PNN has reported, Proove’s headquarters in Irvine, California was raided by FBI agents last month, along with doctors affiliated with Proove in California, Florida and Kentucky. At the time, the FBI would only say the raids were part of a healthcare fraud investigation.
STAT News reported in February that the FBI and the Inspector General for the Department of Health and Human Services (HHS) were investigating possible criminal activity at Proove. Former and current employees interviewed by the FBI said agents were focused on illegal kickbacks to doctors who encouraged patients to take Proove’s DNA tests. Physicians reportedly could make $144,000 a year in kickbacks that were called “research fees.”
"Proove has been subject to a handful of inaccurate stories,” Proove said in a statement last month. “We can no longer ignore these false stories based on unreliable sources, and filled with erroneous accusations... spread by a few disgruntled former employees and consultants.”
In all, 412 defendants have been charged nationwide in what the Justice Department calls its “largest ever health care fraud enforcement action.” Most of the charges, according to prosecutors, involve the illegal distribution of painkillers and $1.3 billion in various billing schemes that targeted Medicare, Medicaid and TRICARE, a health insurance program for veterans and their families.
Attorney General Jeff Sessions said nearly 300 health care providers were being suspended or banned from participating in federal health programs.
“Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” said Sessions. “Amazingly, some have made their practices into multi-million dollar criminal enterprises. They seem oblivious to the disastrous consequences of their greed. Their actions not only enrich themselves often at the expense of taxpayers but also feed addictions and cause addictions to start.”
Proove’s ‘Peer Reviewed’ Studies
Proove Biosciences promotes itself as a “leader in personalized pain medicine” and claims its genetic tests have been proven effective in clinical studies at identifying medications that can best treat pain and other health conditions. Critics say most Proove studies are not peer-reviewed and one genetic expert told STAT News the studies were “hogwash.”
Last month Proove claimed in a press release that 91% of patients in a peer-reviewed study reported pain relief after treatment changes prompted by its genetic tests. The press release said the study -- conducted by Katrina Lewis, MD, a member of Proove's medical advisory board who works at Benefis Pain Management Center in Great Falls, Montana – was “accepted for publication by the Journal of Addiction Research & Therapy.”
Not only has the study still not been published, but the journal’s publisher has been accused by the Federal Trade Commission (FTC) of deceiving researchers and readers about the true nature of its publications and peer review process.
According to the FTC complaint filed last August, OMICS International has created hundreds of "open access" online medical journals that publish articles with little or no peer review.
Researchers are also charged significant fees to get their articles published by OMICS, a "pay to play" policy that some consider unethical because it diminishes the quality of academic journals and the peer review process.
According to its website, OMICS publishes a dizzying array of over 700 online medical and scientific journals, ranging from the Journal of Hepatitis to the Journal of Yoga and Physical Therapy, "the official journal of Yoga Federation of Russia and the Hong Kong Yoga Association."
“In reality, many of Defendants’ online publications do not adopt the rigorous peer review practices that are standard in the scholarly journal publishing industry,” the FTC complaint says. “In numerous instances, individuals who have agreed to serve as peer reviewers for Defendants either never receive any manuscripts to review or discover that, when they access the online manuscript review system to review their assigned articles, the articles have already been approved for publication. In addition, in numerous instances, consumers receive no edits or, at most, only stylistic edits before Defendants publish the work.”
"As for the Journal of Addiction Research & Therapy, Proove can only speak to its experience with this particular journal and cannot comment on the allegations by the FTC," said CEO Meshkin. "Specifically for papers submitted to this journal, our R&D team and academic collaborators engaged in documented, extensive peer-review, received suggested edits and provided responses to the suggested edits to the manuscripts submitted for review and publication. Thus, Proove would certainly consider the publications accepted from Proove-affiliated authors in that journal to be 'peer-reviewed'."
In March, OMICS published in the Journal of Addiction Research & Therapy a study by Proove which found that one of the company’s genetic tests could identify patients at high-risk of developing opioid use disorder. Proove said in a news release the study had been peer reviewed.
In April, a second Proove study was published in Pharmacogenomics and Personalized Medicine, an online journal published by Dove Medical Press, another so-called predatory publisher that charges high fees to researchers to get their studies into medical journals.
"This is the first of many peer-reviewed publications over the next several months demonstrating the validity of Proove Opioid Risk (test), building on the existing published evidence," Dr. Svetlana Kantorovich, Proove's Research and Development director said in a news release.