At a tiny kiosk on a Mumbai lane choked with rickshaws, Chandrabhaan Chaurasia is selling paan – betel leaves sprinkled with spices. They’re a cheap street snack across South Asia.

Chaurasia, 51, spreads a leaf with spicy herbal paste and then sprinkles it with dried tobacco. He folds the leaf into an edible little parcel, and sells it for 8 rupees — about $0.11. He also sells single-serving packs of chewing tobacco. Another kiosk nearby sells hand-rolled leaf cigarettes, called beedis.

India banned electronic cigarettes last month. With about 100 million smokers, India has the second-largest smoking population in the world, after China. Amid global reports of deaths and illnesses linked to vaping, India decided to ban e-cigarettes preventatively. They had yet to become popular.

But other forms of tobacco already are. In fact, twice as many Indians (about 200 million) use smokeless tobacco — like paan or chewing tobacco — than cigarettes. That’s the most in the world. Those products are harder to regulate because they’re mostly sold at street kiosks, for a fraction of the price of cigarettes.

Chaurasia’s tobacco kiosk is right outside Tata Memorial Hospital, one of the best cancer research facilities in India. Inside the hospital, Dr. Gauravi Mishra, a preventative oncologist, sees the harmful effects of those tobacco products on a daily basis.

“India has the highest number of oral cavity cancers. In fact, one-third of the global burden comes from only one country — and that’s India,” Mishra notes.

In the United States, oral cavity cancer represents 3% of all malignancies. But in India, it accounts for over 30% of all cancers.

When NPR visited her office, Mishra had just biopsied a boil inside the mouth of a patient who’s been chewing tobacco for 10 years.

“I had some idea that it was bad, but I didn’t know it could be so serious,” says Madhukar Patil, 42, his mouth filled with sterile gauze.

Patil is waiting for results to determine whether he has oral cancer. A father of two, he vows to quit tobacco now, for good.

“I realize now that if you want to be there for your family and enjoy precious moments with them, then you must leave this bad habit,” Patil says.

More than one in five Indians over the age of 15 uses some form of smokeless tobacco. (The figure is nearly one-third for men.) Poor laborers often chew tobacco as a stimulant, like chewing gum, to kill their appetite. Some even use tobacco ash as toothpaste. Patil used to chew gutka, a mixture of granular tobacco, betel nuts and spices.

Part of the problem is awareness.

“If someone is smoking, they might be looked down upon. But smokeless tobacco is culturally accepted. If you visit any rural area, people will greet you with paan,” Mishra says.

Another part of the problem is packaging.

Indian law requires cigarette companies to print health warnings on cigarette packs. Often, they carry graphic photos of tobacco-related tumors. So people know that smoking cigarettes is bad.

But other tobacco products are sold loose. Hand-rolled leaf cigarettes, or beedis, are green. They look organic. And they’re seven to eight times more common in India than conventional cigarettes, according to the World Health Organization.

Beedis also provide a livelihood to millions of mostly female, first-time workers.

In Mumbai’s oldest red light district, Balamani Sherla rolls beedis on the floor of her one-room home. At 60, Sherla has been doing this for half a century. It’s the only job she’s ever held.

She buys the ingredients wholesale: tendu leaves, dried loose tobacco, and string to tie off the rolled beedis. Sherla soaks the leaves in water to soften them, then cuts them round with giant shears, lines them with tobacco, and rolls them into short green cigarettes. She sells them to a middle man who then distributes them to street kiosks.

“It’s tedious work,” she says. “My arms ache, trying to roll the beedis very thin.”

Sherla doesn’t smoke. But studies show that beedi rollers often suffer from respiratory problems, burning eyes and asthma – just from breathing tobacco dust.

Nevertheless, it’s considered such a lucrative skill that women who can roll beedis are coveted as brides. Sherla makes about $0.14 an hour, which is a big help for her family, she says.

But wages used to be higher. The Indian government has repeatedly hiked tax on all tobacco products, including beedis — and that has cut into Sherla’s profits.

Most of the revenue India collects from taxing tobacco comes from packaged cigarettes, even though they’re less popular than beedis and smokeless tobacco. Tax rates on all tobacco products in India fall below the WHO’s recommendation of 75-percent of retail price.

Levying taxes on tobacco has long been considered an effective strategy to discourage its use and improve public health. But in India, where beedi workers often come from very low socio-economic backgrounds, that tax itself could be deadly, says Umesh Vishwad, general secretary of the Akhil Bharatiya Beedi Mazdoor Mahasangh (All India Beedi Workers Union).

If taxes on beedis keep rising, workers could “become homeless and starve to death,” Vishwad says.

They live that close to the bone, he says. His group wants the Indian government to retrain beedi workers for other jobs, before it chips away at their livelihood.

While Sherla and some of her neighbors roll beedis at home in urban Mumbai, the industry employs more people in rural areas, especially in the southern Indian states of Telangana and Andhra Pradesh. In central India, some of the beedi workers come from tribal areas where communist guerrillas are active. Vishwad worries that if their livelihoods are threatened, they could be vulnerable to insurgent recruiters.

“If these people lose their jobs as beedi rollers or beedi leaf collectors, they could be forced to join the militancy and pick up arms to survive,” he warns.

For Sherla, rolling beedis is a calculated decision. She knows that handling tobacco may not be good for her health. But she’s trading a long-term health risk for the ability to feed her family tomorrow.

“What other job can I do? I’m an old lady,” Sherla says. “This is the only option for me.”

As she works, Sherla’s 10-year-old granddaughter Siri bounces around the dank little room. The girl goes to school, and has learned English well. She interrupts often to tease her grandmother and translate for her. She’s the same age Sherla was when she started doing this work.

Will Siri follow in her grandmother’s footsteps?

“No way!” Sherla exclaims. “This little girl wants to be a doctor.”

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Vowing to protect Medicare with “every ounce of strength,” President Trump spoke last week to a cheering crowd in Florida. But his executive order released shortly afterward includes provisions that could significantly alter key pillars of the program by making it easier for beneficiaries and doctors to opt out.

The bottom line: The proposed changes might make it a bit simpler to find a doctor who takes new Medicare patients, but it could lead to higher costs for seniors and potentially expose some to surprise medical bills, a problem from which Medicare has traditionally protected consumers.

“Unless these policies are thought through very carefully, the potential for really bad unintended consequences is front and center,” says economist Stephen Zuckerman, vice president for health policy at the Urban Institute.

While the executive order spells out few details, it calls for the removal of “unnecessary barriers” to private contracting, which allows patients and doctors to negotiate their own deals outside of Medicare. It’s an approach long supported by some conservatives, but critics fear it would lead to higher costs for patients. The order also seeks to ease rules that affect beneficiaries who want to opt out of the hospital portion of Medicare, known as Part A.

Both ideas have a long history, with proponents and opponents duking it out since at least 1997, even spawning a tongue-in-cheek legislative proposal that year titled, in part, the “Buck Naked Act.” More on that later.

“For a long time, people who don’t want or don’t like the idea of social insurance have been trying to find ways to opt out of Medicare and doctors have been trying to find a way to opt out of Medicare payment,” says Timothy Jost, emeritus professor at Washington and Lee University School of Law in Virginia.

The specifics will not emerge until the Department of Health and Human Services writes the rules to implement the executive order, which could take six months or longer. In the meantime, here are a few things you should know about the possible Medicare changes.

What are the current rules about what doctors can charge in Medicare?

Right now, the vast majority of physicians agree to accept what Medicare pays them and not charge patients for the rest of the bill, a practice known as balance billing. Physicians (and hospitals) have complained that Medicare doesn’t pay enough, but most participate anyway. Still, there is wiggle room.

Medicare limits balance billing. Physicians can charge patients the difference between their bill and what Medicare allows, but those charges are limited to 9.25% above Medicare’s regular rates. But partly because of the paperwork hassles for all involved, only a small percentage of doctors choose this option.

Alternatively, physicians can “opt out” of Medicare and charge whatever they want. But they can’t change their mind and try to get Medicare payments again for at least two years. Fewer than 1% of the nation’s physicians have currently opted out.

What would the executive order change?

That’s hard to know.

“It could mean a lot of things,” says Joseph Antos at the American Enterprise Institute, including possibly letting seniors make a contract with an individual doctor or buy into something that isn’t traditional Medicare or the current private Medicare Advantage program. “Exactly what that looks like is not so obvious.”

Others say eventual rules might result in lifting the 9.25% cap on the amount doctors can balance-bill some patients. Or the rules around fully “opting out” of Medicare might ease so physicians would not have to divorce themselves from the program or could stay in for some patients, but not others. That could leave some patients liable for the entire bill, which might lead to confusion among Medicare beneficiaries, critics of such a plan suggest.

The result may be that “it opens the door to surprise medical billing if people sign a contract with a doctor without realizing what they’re doing,” says Jost.

Would patients get a bigger choice in physicians?

Proponents say allowing for more private contracts between patients and doctors would encourage doctors to accept more Medicare patients, partly because they could get higher payments. That was one argument made by supporters of several House and Senate bills in 2015 that included direct-contracting provisions. All failed, as did an earlier effort in the late 1990s backed by then-Sen. Jon Kyl, R-Ariz., who argued such contracting would give seniors more freedom to select doctors.

Then-Rep. Pete Stark, D-Calif., opposed such direct contracting, arguing that patients had less power in negotiations than doctors. To make that point, he introduced the “No Private Contracts To Be Negotiated When the Patient Is Buck Naked Act of 1997.”

The bill was designed to illustrate how uneven the playing field is by prohibiting the discussion of or signing of private contracts at any time when “the patient is buck naked and the doctor is fully clothed (and conversely, to protect the rights of doctors, when the patient is fully clothed and the doctor is naked).” It, too, failed to pass.

Still, the current executive order might help counter a trend that “more physicians today are not taking new Medicare patients,” says Robert Moffit, a senior fellow at the Heritage Foundation, a conservative think tank based in Washington, D.C.

It also might encourage boutique practices that operate outside of Medicare and are accessible primarily to the wealthy, says David Lipschutz, associate director of the Center for Medicare Advocacy.

“It is both a gift to the industry and to those beneficiaries who are well off,” he says. “It has questionable utility to the rest of us.”

KHN is a nonprofit, editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

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Lawmakers in Congress are calling on the Department of Labor to do more to protect workers who may be unsafely cutting “engineered stone” used for countertops.

The material contains high levels of the mineral silica, and breathing in silica dust is dangerous. While silica is found in natural stones, like granite, engineered stone made of quartz can be more than 90% silica.

This type of artificial stone has become increasingly popular among Americans for kitchen and bathroom countertops in recent years.

Even though adequate dust control can completely eliminate the risk of silica-related disease, at least 18 workers in California, Colorado, Texas and Washington who cut slabs of this material to order have recently suffered severe lung damage, according to physicians and public health officials.

Two of the workers died of their silicosis, a lung disease that can be progressive and has no treatment except for lung transplant. That has occupational safety experts worried about the nearly 100,000 people who work in this industry.

And it’s gotten the attention of the House Committee on Education and Labor. Its chairman, Bobby Scott, and Alma Adams, who chairs a subcommittee on workforce protections, have now written to Labor Department Secretary Eugene Scalia.

The lawmakers say the department’s Occupational Safety and Health Administration needs to create a new National Emphasis Program that will make it easier to for the agency to inspect workplaces that cut engineered stone, to make sure levels of silica dust are within allowable limits.

“We are calling on OSHA to issue, without delay, a new NEP that focuses on engineered stone fabrication establishments,” the lawmakers write. “Absent timely action, OSHA will be failing these stone finishing workers and failing in its mission.”

Without this new program, they say, “it is difficult for OSHA to enter a workplace without a worker complaint, injury, or referral.”

The two lawmakers also call on OSHA to work with the CDC and state health departments to improve surveillance for silica-related diseases. They say they want an update on the plans to protect workers in the engineered stone fabrication industry by Oct. 21.

A trade organization for makers of engineered stone, A.St.A. World-Wide, has told NPR that “these risks are not specific to engineered stone” and that dust related diseases “preceded the invention of engineered stone by many decades.”

The group said engineered stone surfaces “are totally safe in their fabrication and installation if it is performed according to the recommended practices,” and that manufacturers have been working to educate fabricators about these practices.

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Updated at 4:30 p.m. ET

President Trump gave a speech and signed an executive order on health care Thursday, casting the “Medicare for All” proposals from his Democratic rivals as harmful to seniors.

His speech, which had been billed as a policy discussion, had the tone of a campaign rally. Trump spoke from The Villages, a huge retirement community in Florida outside Orlando, a deep-red part of a key swing state.

His speech was marked by cheers, standing ovations and intermittent chants of “four more years” by an audience of mostly seniors.

Trump spoke extensively about his administration’s health care achievements and goals, as well as the health policy proposals of Democratic presidential candidates, which he characterized as socialism.

The executive order he signed had previously been titled “Protecting Medicare From Socialist Destruction” on the White House schedule but has since been renamed “Protecting and Improving Medicare for Our Nation’s Seniors.”

“In my campaign for president, I made you a sacred pledge that I would strengthen, protect and defend Medicare for all of our senior citizens,” Trump told the audience. “Today I’ll sign a very historic executive order that does exactly that — we are making your Medicare even better, and … it will never be taken away from you. We’re not letting anyone get close.”

The order is intended, in part, to shore up Medicare Advantage, an alternative to traditional Medicare that’s administered by private insurers. That program has been growing in popularity, and this year, premiums are down and plan choices are up.

The executive order directs the Department of Health and Human Services to develop proposals to improve several aspects of Medicare, including expanding plan options for seniors, encouraging innovative plan designs and payment models and improving the enrollment process to make it easier for seniors to choose plans.

The order includes a grab bag of proposals, including removing regulations “that create inefficiencies or otherwise undermine patient outcomes”; combating waste, fraud and abuse in the program; and streamlining access to “innovative products” such as new treatments and medical devices.

The president outlined very little specific policy in his speech in Florida. Instead, he attacked Democratic rivals and portrayed their proposals as threatening to seniors.

“Leading Democrats have pledged to give free health care to illegal immigrants,” Trump said, referring to a moment from the first Democratic presidential debate in which all the candidates onstage raised their hands in support of health care for undocumented migrants. “I will never allow these politicians to steal your health care and give it away to illegal aliens.”

Health care is a major issue for voters and is one that has dominated the presidential campaign on the Democratic side. In the most recent debate, candidates spent the first hour hashing out and defending various health care proposals and visions. The major divide is between a Medicare for All system — supported by only two candidates, Sen. Bernie Sanders and Sen. Elizabeth Warren — and a public option supported by the rest of the field.

Trump brushed those distinctions aside. “Every major Democrat in Washington has backed a massive government health care takeover that would totally obliterate Medicare,” he said. “These Democratic policy proposals … may go by different names, whether it’s single payer or the so-called public option, but they’re all based on the totally same terrible idea: They want to raid Medicare to fund a thing called socialism.”

Toward the end of the speech, he highlighted efforts that his administration has made to lower drug prices and then suggested that drugmakers were helping with the impeachment inquiry in the House of Representatives. “They’re very powerful,” Trump said. “I wouldn’t be surprised if … it was from some of these industries, like pharmaceuticals, that we take on.”

Drawing battle lines through Medicare may be a savvy campaign move on Trump’s part.

Medicare is extremely popular. People who have it like it, and people who don’t have it think it’s a good thing too. A recent poll by the Kaiser Family Foundation found that more than 8 in 10 Democrats, independents and Republicans think of Medicare favorably.

Trump came into office promising to dismantle the Affordable Care Act and replace it with something better. Those efforts failed, and the administration has struggled to get substantive policy changes on health care.

On Thursday, administration officials emphasized a number of its recent health care policy moves.

“[Trump’s] vision for a healthier America is much wider than a narrow focus on the Affordable Care Act,” said Joe Grogan, director of the White House’s Domestic Policy Council, at a press briefing earlier.

The secretary of health and human services, Alex Azar, said at that briefing that this was “the most comprehensive vision for health care that I can recall any president putting forth.”

He highlighted a range of actions that the administration has taken, from a push on price transparency in health care, to a plan to end the HIV epidemic, to more generic-drug approvals. Azar described these things as part of a framework to make health care more affordable, deliver better value and tackle “impassable health challenges.”

Without a big health care reform bill, the administration is positioning itself as a protector of what exists now — particularly Medicare.

“Today’s executive order particularly reflects the importance the president places on protecting what worked in our system and fixing what’s broken,” Azar said. “Sixty million Americans are on traditional Medicare or Medicare Advantage. They like what they have, so the president is going to protect it.”

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Brianna Snitchler was just figuring out the art of adulting when she scheduled a biopsy at Henry Ford Hospital in Detroit.

Snitchler, 27, was on top of her finances: Her student loan balance was down and her credit score was up.

“I had been working for the past three years trying to improve my credit and, you know, just become a functioning adult human being,” Snitchler said.

For the first time in her adult life, she had health insurance through her job and a primary care doctor she liked. Together they were working on Snitchler’s concerns about her mental and physical health.

One concern was a cyst on her abdomen. The growth was about the size of a quarter, and it didn’t hurt or particularly worry Snitchler. But it did make her self-conscious whenever she went for a swim.

“People would always call it out and be alarmed by it,” she recalled.

Before having the cyst removed, Snitchler’s doctor wanted to check the growth for cancer. After a first round of screening tests, Snitchler had an ultrasound-guided needle biopsy at the Henry Ford Health System’s main hospital.

The procedure was “uneventful,” with no complications reported, according to results faxed to her primary care doctor after the procedure. The growth was indeed benign, and Snitchler thought her next step would be getting the cyst removed.

Then the bill came.

The patient: Brianna Snitchler, 27, a user-experience designer living in Detroit at the time. As a contractor for Ford Motor Co., she had a UnitedHealth Group insurance plan.

Total bill: $3,357.52, including a $2,170 facility fee listed as “operating room services.” The balance included a biopsy, ultrasound, physician charges and lab tests.

Service provider: Henry Ford Health System in Detroit.

Medical procedure: Ultrasound-guided needle biopsy of a cyst.

What gives: When Snitchler scheduled the biopsy, no one told her that Henry Ford Health System would also charge her a $2,170 facility fee.

Snitchler said the bill turned out to be far more than what she had budgeted for. Her insurance plan from UnitedHealth had a high deductible of $3,250, plus she would owe coinsurance. All told, her bills for the care she received related to the biopsy left her on the hook for $3,357.52, with her insurance paying $974.

“She shrugged it off,” Snitchler’s partner, Emi Aguilar, recalled. “But I could see that she was upset in her eyes.”

Snitchler panicked when she realized the bill threatened the couple’s financial security. Snitchler had already spent down her savings for a recent cross-country move to Austin, Texas.

In an email, Henry Ford spokesman David Olejarz said the “procedure was performed in the Interventional Radiology procedure room, where the imaging allows the biopsy to be much more precise.”

“We perform procedures in the most appropriate venue to ensure the highest standards of patient quality and safety,” Olejarz wrote.

The initial bill from Henry Ford referred to “operating room services.” The hospital later sent an itemized bill that referred to the charge for a treatment room in the radiology department. Both descriptions boil down to a facility fee, a common charge that has become controversial as hospitals search for additional streams of income, and as more patients complain they’ve been blindsided by these fees.

Hospital officials argue that medical centers need the boosted income to provide the expensive care sick patients require, 24 hours a day, 365 days a year.

But the way hospitals calculate facility fees is “a black box,” said Ted Doolittle, with the Office of the Healthcare Advocate for Connecticut, a state that has put a spotlight on the issue.

“It’s somewhat akin to a cover charge” at a club, said Doolittle, who previously served as deputy director of the federal Center for Program Integrity at the Centers for Medicare & Medicaid Services.

Hospitals in Connecticut billed more than $1 billion in facility fees in 2015 and 2016, according to state records. In 2015, Connecticut lawmakers approved a bill that forces all hospitals and medical providers to disclose facility fees upfront. Now patients in Connecticut “should never be charged a facility fee without being shown in burning scarlet letters that they are going to get charged this fee,” Doolittle said.

In Michigan, there’s no law requiring hospitals and other providers of health care services to inform patients of facility fees ahead of time.

Snitchler’s procedure took place on campus at Henry Ford’s main hospital site. When she got her bill, with its mention of “operating room services,” she was baffled. Snitchler said the room had “crazy medical equipment,” but she was still in her street clothes as a nurse numbed her cyst, and she was sent home in a matter of minutes.

With Snitchler’s permission, Kaiser Health News shared her itemized bill, biopsy results and explanation of benefits with Mark Weiss, a radiologist who leads MediCrew, a company in Flint, Mich., that helps patients navigate the health system.

Weiss said it probably wasn’t medically necessary for Snitchler to go to the hospital to receive good care. “Not all surgical procedures have to be done at a surgical center,” he said, noting that biopsies often can be done in an office-based treatment center.

Resolution: Hoping for a reasonable explanation — or even the discovery of a mistake — Snitchler called her insurance company and the hospital.

A representative at Henry Ford told her on the phone that the hospital isn’t “legally required” to inform patients of fees ahead of time.

In an email, Henry Ford spokesman Olejarz apologized for that response: “We’ll use it as a teachable moment for our staff. We are committed to being transparent with our patients about what we charge.”

He pointed to an initiative launched in 2018 that helps patients anticipate out-of-pocket expenses. The program targets the most common elective radiology and gastroenterology tests that often have high price tags for patients.

Asked if Snitchler’s ultrasound-guided needle biopsy will be included in the price transparency initiative, Olejarz replied, “Can’t say at this point.”

In addition to the pilot program to inform patients of fees, Olejarz said, the hospital also plans to roll out an online cost-estimator tool.

For now, Snitchler has decided not to get the cyst removed, and she plans to try to negotiate on her bill. She has not yet paid any portion of it.

“You should always negotiate; you should always try,” Doolittle said. “Doesn’t mean it’s going to work, but it can work. People should not be shy about it.”

“We are happy to work out a flexible payment plan that best meets her needs,” Olejarz wrote when Kaiser Health News first inquired about Snitchler’s bill.

The takeaway: When your doctor recommends an outpatient test or procedure like a biopsy, be aware that the hospital may be the most expensive place you can have it done. Ask your physician for recommendations of where else you might have the procedure, and then call each facility to try to get an estimate of the costs you’d face.

Also, be wary of places that may look like independent doctor’s offices but are owned by a hospital. These practices also can tack hefty facility fees onto your bill.

If you get a bill that seems inflated, call your hospital and insurer and try to negotiate it down.

Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

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In announcing a crackdown Friday on companies it says were involved in fraudulent genetic testing, the U.S. Department of Justice brought charges against 35 individuals associated with dozens of telemarketing companies and testing labs.

The federal investigation, called Operation Double Helix, went after schemes that allegedly targeted people 65 and older. According to the charges, the schemes involved laboratories paying illegal kickbacks and bribes to medical professionals who were working with fraudulent telemarketers, in exchange for the referral of Medicare beneficiaries.

DOJ officials say the schemes cost the Medicare program more than $2 billion in unnecessary charges.

Among those charged were 10 medical professionals, including nine doctors.

“The elderly and disabled are being preyed upon,” says Joe Beemsterboer, senior deputy chief of the fraud section in the criminal division of the DOJ.

It was one of the largest health care fraud schemes in U.S. history, Beemsterboer, says, and it worked on many levels, involving many players — from “those collecting patient information, to those selling it, to those doctors corruptly prescribing these genetic tests, to the labs corruptly billing the Medicare program.”

According to Shimon Richmond, assistant Inspector General for investigations with the U.S. Department of Health and Human Services, this is how the alleged scheme worked: First, telemarketing companies trolled elderly Medicare beneficiaries online, or called them on the phone or even sent people to approach beneficiaries face-to-face at health fairs, senior centers, low-income housing areas or religious institutions like churches and synagogues.

Seniors were offered, at no cost to them, genetic testing to estimate their cancer risk or determine how well certain drugs would work for them. All they had to do, the elderly people were told, was provide their Medicare information, a copy of their driver’s license and a bit of DNA collected from a swab of saliva from inside their cheek.

The sales pitch also included lots of aggressive scare tactics, Richmond says, such as telling patients that if they didn’t have the testing done they could end up suffering from a variety of possibly fatal conditions.

Once recruiters got the information they wanted, they would try to get the patient’s own health care provider to write a prescription for the test. If that didn’t work, the recruiters asked one of their own cadre of doctors to write prescriptions for patients they didn’t know.

“And these doctors, in many cases, have zero contact with the patient and no knowledge of their health care situation or needs,” Richmond says.

The genetic test may have been offered free to the patients, but there was money to be made from Medicare reimbursement. Typically that payment – anywhere from $10,000 to $18,000 or more, Richmond says — would be split between the worker who recruited the patient, the doctor writing the prescription, the lab that did the test and the telemarketing company that organized the alleged scheme.

Often, the labs didn’t even send results to patients, Richmond says. And when they did there was no counseling or help interpreting the findings.

“So patients were left with a report that’s meaningless to them, and is certainly not providing them with any benefit in terms of their health care,” says Richmond.

The testing could also financially harm the patient down the road, he adds. For example, if, in the future, the patient’s legitimate doctor determines that the patient actually needs a genetic test for a certain condition, Medicare likely won’t cover it, citing an earlier payment.

The U.S. Department of Health and Human Services Office of Inspector General has previously issued a fraud alert for consumers in an effort to educate the public about such schemes.

Richmond says people who believe they may have been victimized by the schemes can call 1-800-HHS-TIPS, or they can file a complaint online.

If convicted, the defendants arrested Friday could face decades in prison, Beemsterboer says.

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