20 Sep BBB on Seniors: Fraud alert — Be on lookout for genetic tes…
This article is an update on the genetic testing scam that has been running rampant since we first introduced it here a few months ago.
The BBB Education Foundation’s Texas Senior Medicare Patrol has been getting up to five calls every day with reports of scammers attempting to defraud individuals with this scheme; and the U.S. Department of Health and Human Services Office of the Inspector General has recently issued a fraud alert to address this very issue. Be especially cautious of any offers for “free” genetic testing and review the who, what, where, and why of this scam to save yourself from a hefty bill.
Who is at risk? Medicare beneficiaries.
What’s the scam? A company offering you “free” testing without a treating physician’s order and then billing Medicare. These tests go by many names. Here are some examples to watch for:
Hereditary cancer screening/test
Pharmacogenomics — medication metabolization
Remember, a company providing a test or screening that you never requested or that you do not need. A company billing Medicare for screening services that are not covered by Medicare or for screenings that do not apply to you.
Where does it happen? Look for these:
Local health fairs
Any other community events
Over the phone
Through e-mail, mail, online ads and Facebook
Why are these scams so popular? Genetic testing is extremely expensive and therefore potentially extremely lucrative for fraudulent companies or extremely costly for the victim. Medicare pays for diagnostic lab tests according to a fee schedule, with no deductible or coinsurance costs for patients, but only when medically necessary.
If Medicare denies the tests, you could be charged the entire amount, which could easily run $9,000-$11,000. The genetic testing scams gives fraudsters access to your Medicare information for either fraudulent billing purposes or identity theft.
What can you do? Remember these hints:
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, over the phone, or online.
Always read your Medicare Summary Notice or Explanation of Benefits. 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 the Texas Senior Medicare Patrol at 1-888-341-6187.
Red flags to watch for include:
Requests for your personal information/Medicare number, especially from anyone offering free services
Scare tactics or inflammatory language such as “your prescriptions could kill you,” “to prevent cancer,” and “using the wrong prescription is the biggest killer of seniors.”
For more information, or if you think you have fallen victim to this scam, please contact the Texas Senior Medicare Patrol at 1-888-341-6187.
To report any other scams, call the BBB Education Foundation at 713-341-6141.
Melissa Ramsey is the BBB Education Foundation columnist. For more information, call 713-341-6141.