Medicare Corner
Genetic testing scams are a rapidly emerging fraud trend throughout the country. Scammers are offering Medicare beneficiaries cheek swabs for genetic testing to obtain their Medicare information for fraudulent billing purposes or possibly medical identity theft. What is Genetic Testing Fraud? Genetic testing fraud occurs when Medicare is billed for a test or screening that was not medically necessary and/or was not ordered by a beneficiary’s treating physician. What are Examples of Genetic Testing Fraud? Here are several ways genetic testing is advertised: * Cancer screening / test * Hereditary cancer screening / test * Pharmacogenetics (medication metabolization) * Parkinson’s screening / test * DNA screening / test * Dementia screening / test
• A company offering you “free” or “at no cost to you” testing without a treating physician’s order and then billing Medicare. • A company using “telemedicine” to offer testing to you over the phone and arranging for an unrelated physician or “teledoc” to order the test.
• Billing Medicare (usually thousands of dollars) for a broad range of genetic tests that you did not request or possibly even receive. • Billing Medicare for pharmacogenomic tests (to determine how you metabolize drugs) that are not covered by Medicare or apply to you.
• A company requesting your Medicare number (or possibly driver’s license) at health fairs, senior centers, assisted living facilities, malls, farmers markets, parking lots outside retail stores, home shows, or church-sponsored wellness events.
What is Medical Identity Theft? When someone steals or uses your Medicare number to submit fraudulent claims to Medicare without your authorization. Medical identity theft may disrupt your medical care and/or result in financial harm. What Can You Do to Stop Genetic Testing Fraud?
• Be sure your doctor has assessed your condition. Although Medicare covers many genetic tests for diagnostic use, it only covers one preventative genetic test to screen for cancer. • Be sure your doctor has assessed your condition. Although Medicare covers many genetic tests for diagnostic use, it only covers one preventative genetic test to screen for cancer. • Do not give out your personal information or accept screening services from someone at a community event, a local fair, a farmer’s market, a parking lot, or any other event.
• Always read your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB). The words “gene analysis,” “molecular pathology,” or “laboratory” may indicate questionable genetic testing has occurred. • If you received a cheek swab or a screening that was not medically necessary, report your concerns about billing errors or possible fraud and abuse to your local SMP.Do not give out your personal information or accept screening services from someone at a community event, a local
fair, a farmer’s market, a parking lot, or any other event. • Always read your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB). The words “gene analysis,” “molecular pathology,” or “laboratory” may indicate questionable genetic testing has occurred. • If you received a cheek swab or a screening that was not medically necessary, report your concerns about billing errors or possible fraud and abuse to your local SMP.
This project was supported in part by grant number 90MPPG0022, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy
Page 6 | December 2022, Never Too Late
Pima Council on Aging
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