Late last year, an alert was issued by the U.S. Department of Health and Human Services Office of Inspector General. This alert was about a fraud scheme involving genetic testing. The scam is perpetrated on the Medicare system at large and individual level.
The warning? Medicare beneficiaries across the nation are the target of healthcare fraud.
It is such a big deal that federal government and law enforcement are working to put an end to such schemes. When this alert was issued, 35 individuals were isolated for their alleged participation in healthcare fraud that accounted for for $2.1 billion dollars in losses nationwide.
Here's how the scheme works:
- First, the recruiters (scammers) will pretend to involve themselves with their targeted Medicare seniors. Scammers often target the victim by making 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 often begins with an offer for a free screening. This is a testing kit is sent to the senior's home via mail. Alternatively seniors can have an on-site cheek swab performed. They then provide a senior's s Medicare information to use it for fraudulent billing or identity theft.
- Tests can also be ordered by unethical doctors. Scammers will pay such doctors 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-$11,000.
Examples of genetic testing fraud can include, but are not limited to, the following screenings or tests:
- Cancer and hereditary cancer;
- Pharmacogenomics (medication metabolization).
What is the best way to avoid the genetic testing scam?
- Alert your loved ones who are an ideal target for these sorts of scams. If they receive a genetic testing kit in the mail, they should not accept it unless they are sure their physician ordered it. Do not open the testing kit until it is certain it was sent from a doctor-approved company. If their physician did not order the test, it is best to refuse delivery of the kit or return it unopened to the sender. Be sure to keep record of the sender's name and the date the item was returned.
- 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 a Medicare number. Once Medicare data has been shared, it is easy for a scammer to compromise that data in additional fraud schemes. If anyone other than a physician's office is requesting a senior's Medicare number, do not provide it. If you suspect you or a senior in your life are a target, report the incident immediately to the HHS OIG Hotline.
- Be sure to always review Medicare Summary Notices (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. These suspicions should be immediately reported as a billing error or possible fraud to Senior Medicare Patrol (SMP) or the HHS OIG Hotline.
Genetic testing is a useful 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 ancestors and assess 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 seniors and their personal information to avoid being a victim.
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