Each year, the Medicare program loses $60 billion to fraud. The best way to reduce this figure is beneficiary education to prevent and reduce known pathways to fraudulent activities and unethical billing practices. The SHINE Senior Medicare Patrol Program has been hearing about DNA and genetic testing schemes in other parts of the country, and we recently learned that they are starting here in Florida.
WHAT IS THE SCAM? Older adults at senior centers, housing complexes, and other community locations are targeted by companies promoting “free” genetic testing, cancer screening, or DNA testing. During an event, beneficiaries are asked to swab their cheek to collect a DNA sample which will be sent to the lab for analysis. They are then told falsely that the test will be covered by Medicare 100 percent, and all that is needed to process it is their Medicare number. This scam is resulting in fraudulent Medicare charges.
OTHER VARIATIONS OF THIS SCAM? Yes. Some Medicare beneficiaries are being contacted at home by phone and told that they will be sent a DNA testing kit in the mail. In these cases, the person is asked to perform the cheek swab at home and then return the kit in the mail for DNA analysis. The caller then asks for the person’s Medicare number and reiterates that there will be no charge to the beneficiary. This is also false.
WHAT YOU NEED TO KNOW: All diagnostic X-rays tests, diagnostic laboratory tests, and other diagnostic tests must be ordered by the physician who is treating the beneficiary, that is, the physician who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary’s specific medical problem. Tests not ordered by the physician who is treating the beneficiary are not reasonable and necessary (emphasis added). Medicare only covers one genetic test to screen for a cancer, i.e., Cologuard for colorectal cancer. The posturing of any other genetic test as a Medicare-covered screening benefit (available for free no less) should send up a red flag.