ALERT! Medicare/Medicaid Fraud

May 5, 2022 | Alerts | By: Kristin Whiteid

Recently our partner practice was informed that their patients have received phone calls from scammers claiming they are calling on behalf of “Genetic Advocates” and “Open Med.” The scammers claim their company has partnered with Centers for Medicare & Medicaid (CMS) to conduct genetic testing. They claim they will send a “free screening kit” to the patient’s home for testing purposes. In reality, the scammers are solely seeking the patient’s Medicare information for identity theft or fraudulent billing purposes. Patients who refuse the genetic testing have been threatened that they will lose their Medicare Part B coverage if they do not agree to the genetic testing.

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) previously issued a fraud alert in September 2019, alerting the public about this type of genetic testing scam. The OIG explained:“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 Medicare beneficiary’s treating physician.” Genetic testing fraud can also be advertised several different ways, such as a hereditary cancer screening test, DNA screening test, or Dementia screening test. If a beneficiary completes the fraudulent genetic testing, the Medicare claim may be denied, leaving the patient responsible for the entire cost of the test, which could be thousands of dollars.

Below are some tips to help protect you against such scams: 

  • Be suspicious of companies contacting you to offer “free” genetic testing or “free” medical equipment in exchange for your Social Security Number, Medicare number, or other personal information.
  • A physician that you know and trust should always be the one to assess your condition and approve any requests for genetic testing.
  • Never share your personal information, such as your Medicare number or Social Security Number, with anyone unless it is one of your trusted healthcare providers.
  • Review your Medicare statements (e.g., Explanation of Benefits or Medicare Summary notice) to ensure all charges and services are billed accurately.
  • Always remain vigilant of unsolicited requests of your Driver’s License, Medicare information, or Social Security Number, particularly during door-to-door visits, health fairs, senior centers, assisted living facilities, malls, farmers markets, parking lot events outside of retail stores, and/or church-sponsored wellness events.
  • If you receive communication from someone offering genetic testing that is at “no cost to you” or “free”, or if you receive a testing kit in the mail that was not ordered by your physician, refuse the delivery or return to sender (if possible); do not provide any information and do not take the test; keep a record of the sender’s name and the date you returned the items; and promptly notify Medicare at 1-800-MEDICARE (1-800-633-4227) and the HHS OIG Hotline at 1-800-HHS-TIPS (1-800-447-8477).

 


References: 
U.S. Department of Health and Human Services. OIG Fraud Alert: Genetic Testing Scam.

Genetic Testing Fraud: Tips for Protecting Yourself and Medicare.