See original blog on the rapid rise of 81419 gene test payments - here. Neither this "rant" nor the original blog use any real lab names.
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Medicare’s $74 Million Epilepsy Gene Giveaway: A Lewis
Black Rant
Let me get this straight — in 2022, Medicare paid for epilepsy gene panel code 81419 a whopping 41 times nationwide. Forty-one. That’s about the same number of people who show up to a 3 a.m. ska festival in Duluth.
Then, in 2024 — a year or two later! — this code
went from “rare genetic test” to “ATM jackpot,” making 30,377 payments, for $74 million.
But wait, there's more. This is the part where my head explodes.
Because where do those millions go? Quest? Ambry? Mayo
Clinic? No! They go to labs with names like they were spit out of a random word
generator on Ambien. “Ace Star Global Lab Genetics LLC.” Sounds like
Marvel villains running a science fair. I half-expect “Zylon Diagnostics LLC”
to be an interdimensional entity from Doctor Strange.
And it’s always in Florida. Or Oklahoma. Or some place where
you can get a CLIA certificate in the time it takes to microwave a burrito.
Formulaic Fraud: The Naming Olympics
Medicare is apparently just writing checks to anything
ending in “Diagnostics LLC” — and the names get better:
- Top
Bio Reference Laboratory, LLC — sounds like a real lab, right? Except
“BioReference” is already a real lab! This is like naming your burger
stand “McDonaldz” and hoping nobody notices.
- Zip
Gene, LLC — I assume they ship your results in 30 minutes or less, or
your genome is free.
- Trust
Results Labs, Inc. — oh good, they put “Trust” in the name, so
there’s nothing to worry about.
- Pro
Meta Metrics Lab Services LLC — which is either a lab or a villain
from a Transformers sequel.
None of these names sound like a place you’d send your kid’s blood sample. They sound like the bad guys in an FDA PowerPoint about “fraud risk scenarios.”
Medicare’s Fraud Prevention: AI in Name Only
And yes, CMS says they’re using “super duper AI” to fight fraud. Oh, really? AI so good that it missed a 741-fold increase in a gene panel no one had heard of, all pouring into the same handful of Novitas and FCSO states..
Here’s a clue: if you plotted the claims data on a graph, a
nine-year-old with an iPad would say, “Mommy, this looks really weird.”
The Real Punchline
The real joke is that everyone knows how this ends: the labs vanish, the money’s gone.
The OIG writes a report three years later with words like
“program vulnerability.” And somewhere in Tulsa, a guy named “CEO & President,
Exon Lab LLC” is buying a yacht.
This is not health policy — it’s a reality show where
Medicare plays “Deal or No Deal” with taxpayer money and the suitcase always
has $74 million in it.
