Every time there’s a medical advance, there’s a scammer waiting around the corner to exploit it. When genetic testing first became an important medical service, scammers targeted cancer screenings and medication metabolization (called pharmacogenetics).
The latest growing genetic testing fraud trend focuses on cardiovascular genetic testing. Scammers are offering Medicare beneficiaries genetic testing cheek swabs to obtain their Medicare information for fraudulent billing purposes or possibly medical identity theft.
“We’re hearing reports of scammers calling Medicare beneficiaries, claiming their cardiologist wants them to have this test and offering to send a kit. In reality, their cardiologist did not make any such request,” said Kathleen Pursell, Arkansas Senior Medicare Patrol (SMP) program director. “Their goal is not to help the beneficiary; it’s to get their Medicare information, which scammers can use to bill Medicare for medically unnecessary genetic testing.”
“The repercussions of falling for a scam of this nature can be devastating. If Medicare denies a cardiovascular genetic test claim, a beneficiary might be responsible for the entire cost of the test: The average cost is $9,000 to $11,000,” said Pursell.
Cardiovascular genetic testing is covered by Medicare when the test is medically reasonable and necessary, when it is ordered by a treating physician, and when a treating physician orders the test as a diagnostic service and uses the results to manage the patient’s condition.
Tips to stop cardiovascular genetic testing fraud:
-- Be sure your doctor has assessed your condition. Although Medicare covers many genetic tests to detect heart disease, these tests do not predict or screen for cardiovascular disease (aka the diseases that affect the heart or blood vessels).
-- Do not give out your personal information to anyone who calls you and claims that your cardiologist has requested cardiovascular testing.
-- Do not give out your personal information or accept screening services from anyone at a community event, local fair, farmers’ market, parking lot, or any other public 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 cardiovascular genetic testing kit or test that was not medically necessary, report your concerns about billing errors or possible fraud and abuse to your local SMP.
The Senior Medicare Patrol (SMP) is ready to provide you with the information you need to protect yourself from Medicare fraud, errors, and abuse; detect potential fraud, errors, and abuse; and report your concerns. SMPs help educate and empower Medicare beneficiaries in the fight against health care fraud. Your SMP can help you with your questions, concerns, or complaints about potential fraud and abuse issues. It also provides information and educational presentations.
To reach the Arkansas Senior Medicare Patrol, contact Kathleen Pursell at 866-726-2916 or email: Kathleen.Pursell@dhs.arkansas.gov