An alert has been issued by the US Department of Health and Human Services Office of Inspector General about a fraud scheme that involves genetic testing. The warning is for Medicare beneficiaries across the nation, and the federal government is working with law enforcement to put an end to the schemes. Already charges against 35 individuals have been brought for their alleged participation in healthcare fraud that accounts for 2.1 billion dollars in losses nationwide. The scam is perpetrated on the Medicare system at large and individual level.
First, the “recruiters” or “marketers” bogusly involve themselves with their targeted Medicare seniors. Typically, the scammer targets the victim through door-to-door visits, telemarketing calls, and booths at public events or health fairs. Some schemes even target retirement communities, offering free ice cream sundaes or gift cards to learn about this fantastic new genetic testing technology.
The deception begins with the offer of “free” screening, testing kit sent to your home via the mail, or an onsite cheek swab for genetic testing followed by obtaining the person’s Medicare information for fraudulent billing activity or identity theft. If the scam artist (“recruiter”) is working with an unethical doctor, they will pay that doctor a kickback in exchange for ordering the test. Once the lab processes the test, Medicare will reimburse the lab, and the lab then shares the proceeds of that reimbursement with the scammer. Genetic testing fraud occurs when an analysis or screening is performed but not ordered by a Medicare beneficiary’s treating physician and not considered medically necessary. If Medicare denies the claim, the recipient who permitted the screening becomes responsible for the entire cost of the test. The average price of personal genetic analysis ranges from 9,000 to 11,000 dollars.
Examples of genetic testing fraud can include, but are not limited to, the following screenings or tests:
- Cancer and hereditary cancer
- Pharmacogenomics or medication metabolization
What is the best way to avoid the genetic testing scam? If you receive a genetic testing kit in the mail, do not accept it unless you are sure your physician ordered it. Make certain it is sent from the doctor-approved company before opening it. If your physician did not order the test, refuse the delivery of it or return it unopened to the sender while keeping a record of the sender’s name and the date the item was returned. You can also report the sender’s information directly to the HHS OIG Hotline. Be skeptical of anyone offering a free genetic testing kit in exchange for providing your Medicare number. Once they have your Medicare data, it is easy for a scammer to compromise your data in additional fraud schemes. Guard your Medicare information, and if anyone other than your physician’s office is requesting your Medicare number, do not provide it. Medicare has a fraud hotline, and if you suspect you are a target, report the incident immediately. Again, you can report or submit a complaint to the HHS OIG Hotline.
Be sure to always review your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB). Certain words or phrases indicate a questionable genetic test may have been completed. Words like laboratory, molecular pathology, and gene analysis are suspect and may indicate fraud, which you should immediately report as a billing error or possible fraud to your Senior Medicare Patrol (SMP) or the Health and Human Services Hotline.
Genetic testing is a fantastic tool made possible by scientific advancement, human genome sequencing, and increased computing capabilities. Twenty-five years ago, obtaining personal genetic information was inconceivable, but today the data can be obtained with a saliva sample. The test can provide information about your ancestors and assess your disease risk. Because the tests are expensive, it did not take long for scam artists to find ways to extract illicit financial gains from Medicare and its beneficiaries. Be aware of how scam artists target you and your personal information to avoid being a victim.
If you need planning assistance for yourself or a loved one, contact our Clarkston, MI office at 248-577-9933.