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September 27, 2019
By Rebecca Kinney, Acting Director, Office of Healthcare Information and Counseling, ACL
Over the past few years, DNA tests have become popular across the country. Unfortunately unscrupulous people are taking advantage of the buzz around these tests to scam Medicare beneficiaries.
Scammers will often target Medicare beneficiaries through telemarketing calls, booths at public events, health fairs, and door-to-door visits. They offer “free” genetic testing to help recipients avoid diseases or find the right medications.
The scammers claim that the testing is covered by Medicare, and therefore is free to the beneficiary. In reality, Medicare only covers genetic testing in limited situations, and only when ordered by the beneficiary’s physician. If a company bills Medicare for genetic testing, and Medicare denies the claim, the beneficiary could be responsible for the entire cost of the test – which often totals around $10,000.
In other cases, the scammers are simply trying to obtain Medicare numbers they can use to steal a beneficiary’s medical identity or to fraudulently bill Medicare for services they did not provide. Such fraud hurts not just Medicare beneficiaries, but all American tax payers whose contributions keep Medicare strong.
The Administration for Community Living (ACL) offers this advice to avoid being scammed:
- Do not accept genetic testing services, including a cheek swab, from someone at a community event, a local fair, a farmer’s market, a parking lot, or any other large event.
- Always be cautious about giving out your personal information, including your Medicare number.
- If you receive a genetic testing kit in the mail, don’t accept it unless it was ordered by your physician. Refuse the delivery or return it to the sender and keep a record of the sender’s name and the date you returned the items.
- Always review your Medicare Summary Notice or Explanation of Benefits. The words “gene analysis” or “molecular pathology” may indicate questionable genetic testing.
- If you received a cheek swab or a screening that was not ordered by a trusted provider, or have any concerns about billing errors or possible fraud, contact your local Senior Medicare Patrol (SMP). The SMP program, funded by the U.S. Administration for Community Living, helps Medicare beneficiaries protect themselves from Medicare fraud, errors, and abuse and detect and report them when they occur. Pro Seniors operates the local SMP program.
More resources:
Department of Justice announcement September 27, 2019: Federal Law Enforcement Action Involving Fraudulent Genetic Testing Results in Charges Against 35 Individuals Responsible for Over $2.1 Billion in Losses in One of the Largest Health Care Fraud Schemes Ever Charged
HHS Office of the Inspector General Media Materials: Nationwide Genetic Testing Fraud
HHS Office of the Inspector General Fraud Alert: Genetic Testing Scam