Action 9: FBI investigates health clinic suspected of fraud with ties to NC

CHARLOTTE, N.C. — The health clinic Primera Medical Group is suspected of fraud in several states.

The FBI is investigating and even raided one of the clinic's offices.  The business offered free tests to tell patients what they're allergic to, but patients told Action 9 investigator Jason Stoogenke that instead of receiving their results, their insurance companies were billed.

Source: Goal was to collect $15 million

A source said the goal of officials at Primera was to collect $15 million from insurers across the U.S. Stoogenke found roughly 100 of the patients were in Charlotte or Raleigh.

Amanda McClain-Wilson and Debbi DiFrancesco both heard about the free allergy tests and signed up.

"I already know I'm allergic to pollen, that wasn't something I was deeply interested in.  It was the food allergy part of it," DiFrancesco said.

In 2015, McClain-Wilson and DiFrancesco gave blood and waited for results. They said results were only supposed to take a few months, but that they still haven't received any.

Stoogenke called or emailed more than a dozen patients in Charlotte and Raleigh.  They all said the same thing: That they didn't get their results.  Some -- like DiFrancesco -- said Primera billed their insurance anyway.  She said Primera billed her insurance $1,800 and that the insurer paid it.

"The fact that I didn't get food allergy results is less important than who's got the sample of blood that I gave and what did they do with it?" DiFrancesco said.  "My DNA."

A patient in Raleigh told Stoogenke that Primera charged her insurance more than $15,000 and that her insurance paid $225 of it.  But, oddly enough, she said no one at Primera never asked her for the rest.

Doctor: “I didn’t sign off” of clinic using name

Another patient told Stoogenke that Primera billed his insurance and listed a Gaston County doctor as the provider.

Stoogenke caught up with that doctor. He asked Channel 9 not to use his name, but said officials with Primera offered him a job years ago, that he turned it down, and that he "didn't sign off" on the clinic using his name.

Forgery conviction

Primera is based in Atlanta, but its employees did screenings across the U.S. The FBI raided Primera's Atlanta office in March, walking away with computers and boxes.

"I was just shocked. I was just shocked," McClain-Wilson said. "These days, it's like you can't trust anyone."

Around the same time, Channel 9's sister station WSB-TV caught up with Shue Kothari, who is listed as Primera’s CEO. He's not a doctor, but a chiropractor with a forgery conviction.

"I'd like to ask you about Primera Medical. Why were you raided by the FBI, sir?" WSB-TV’s reporter asked.

"I'm really not sure. You'll have to speak with my attorney,” Kothari responded.

Research group: “Concerned about the legitimacy”

Primera hired research companies in different cities to line up test subjects.

A spokesperson from a group North Carolina told Stoogenke that patients complained to them about not getting results.

Members of the group became "concerned about the legitimacy of the project" and cut ties with Primera.

They said they then fought with Primera officials to get paid, and that they finally did when lawyers got involved.

A member of the group told Stoogenke that an official with Primera actually contacted the company "again, months after, to see if we would help (Primera) recruit patients again for (their) studies. We declined."

Consumer advice

With the price of health care the way it is, consumers may be tempted to sign up for free medical screenings.

Many of the tests are perfectly legitimate.

But consumers should check with their insurance company first to see if anyone there has heard of the people giving the tests.  Chances are, the insurer offers the same free screening, and with a provider it has already vetted, too.

An official with South Carolina's Department of Consumer Affairs issued the following advice:

"Consumers need to ask questions of the medical provider and their insurance company before they have the tests done. Getting all the information up front from both parties is the best way to ensure that you are signing up for a legitimate test. Many insurance plans offer screenings for consumers at no cost as long as they go to a certain provider, etc. These screenings obviously pose the least amount of financial risk to the consumer and insurance company because the provider and the insurance company have already agreed on the value of the test(s). The best thing to do is contact your insurance company. Ask them what's covered, what free screenings are available to you and how to best take advantage of those screenings." 

Cox Media Group