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genetic testing scams target older adults with dna double helix image

Genetic Testing Fraud Targets Older Adults

Protecting Yourself and Your Medicare Coverage

Article by Texas Senior Medicare Patrol

Genetic testing scams are currently a widespread issue throughout the country. Scammers are offering Medicare beneficiaries cheek swabs for genetic testing to obtain their Medicare information for identity theft or fraudulent billing purposes.

What is Genetic Testing Fraud?

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 beneficiary’s treating physician.

What are Examples of Genetic Testing Fraud?

  • A company offering you “free” testing without a treating physician’s order and then billing Medicare. These tests go by many names and claim to test for many things. Here are some examples of ways you may see this advertised:
    • Cancer screening / test
    • DNA screening / test
    • Hereditary cancer screening / test
    • Dementia screening / test
    • Parkinson’s screening / test
    • Pharmacogenomics – medication metabolization
  • 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.
  • A company requesting your Medicare number at a community event, a local fair, a farmer’s market, a parking lot, or any other event.

What Happens if Medicare Denies the Genetic Test Claims?

You could be responsible for the entire cost of the test! The average is $9,000-$11,000.

What Can You Do to Stop Genetic Testing Fraud?

  • 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, a local fair, a farmer’s market, a parking lot, or any other 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 cheek swab or a screening that was not medically necessary, report your concerns about billing errors or possible fraud and abuse to your local SMP.Do not allow speakers to collect Medicare numbers from attendees.

How the Texas Senior Medicare Patrol (SMP) Can Help

The Texas 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 and their trained volunteers help educate and empower Medicare beneficiaries in the fight against health care fraud. The Texas SMP can help you with your questions, concerns, or complaints about potential fraud and abuse issues. It also can provide information and educational presentations.

REPORT MEDICARE ERROR, FRAUD OR ABUSE TO THE TEXAS SMP:  1-888-341-6187

When are Genetic Tests Covered?

  • When someone has stage III or IV cancer
  • When the test is medically reasonable and necessary
  • Federal regulations define medical necessity as “services or items reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.”
  • When it is ordered by a treating physician
  • Federal regulations define a treating physician as “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.”
  • When one or more coverage requirements are met for colorectal cancer genetic screening
  • There is no other Medicare coverage for genetic testing as a screening service.
  • When a treating physician orders the test as a diagnostic service and uses the results to manage the patient’s condition

How are Fraudsters Benefiting from Genetic Testing Fraud?

See the chart for why this is becoming more prevalent. These services are not free. Each cheek swab could potentially make the company thousands of dollars by billing Medicare and/or you for services that were not needed.

Example Charges for One Cheek Swab

genetic-fraud-cheek-swab-chart

More Tips from the Centers for Medicare & Medicaid Services

Download and share the fact sheet from www.medicare.gov to keep yourself and your loved ones protected from genetic testing scams.

508_eob-genetic-testing-fraud-1-_page_1 508_eob-genetic-testing-fraud-1-_page_2

Supported by a grant (No. 90MPRC0001) from the Administration for Community Living (ACL), U.S. Department of Health and Human Services (DHHS).

Worried elderly man and woman

Protecting Seniors from Health Care Fraud

Health Care Scams Cost Medicare Beneficiaries Billions

Article by Senior Medicare Patrol

The Medicare program and Medicare beneficiaries lose an estimated $60 to $90 billion each year to health care fraud as older adults are increasingly targeted by scam artists. This fact sheet provides basic information and tips you can use to help prevent health care fraud in your facility.

Senior center and senior housing staff are in a unique position to help protect their clients from unscrupulous practices that take money away from much-needed programs and from older adults.

Your clients trust you and often believe that any product, service or activity that your organization directly or indirectly promotes has been properly checked out.

You should know about fraud schemes targeting your community and have practices in place to safeguard your clients. Your local SMP can educate you about local fraud and scams.

Common Health Care Scams that Affect Beneficiaries

  • Services Not Provided – beneficiaries are billed for services never received or health care providers change billing codes or submit fake claims.
  • Medical Equipment Fraud – equipment manufacturers may offer “free” products or waive required copayments or deductibles in exchange for a Medicare number.
  • Free Health Screenings – a vendor offers to provide “free” health care screenings, lab tests or other services but asks for a person’s Medicare number.
  • Insurance Bait & Switch or Cross-selling – licensed agents present information about a Medicare Advantage plan, describing benefits and services that the plan doesn’t actually offer, and then sign people up for a plan that isn’t right for them.
  • Counterfeit Prescription Drugs – beneficiaries purchase medication over the Internet to save money, but the drugs they receive are not the right medication or the right dosage.
  • Medical Identity Theft – this can happen when someone uses a person’s Social Security number or Medicare number, date of birth, credit card number or other personal information. This information can be obtained by asking for it at an event or over the phone or stealing information from a wallet or the trash.

Tips for Protecting Your Clients & Your Organization

  • Do not allow presenters to get names and telephone number from participants.
  • Screen any group that wants to provide information or services to your community – see if they are an approved agency or licensed business. Check with your local SMP, Better Business Bureau or state department of insurance, as appropriate, for complaints.
  • Review all materials that are distributed or promoted in your organization.
  • For any agencies, organizations or individuals who want to offer services through your organization, create written agreements that clarify roles and responsibilities.
  • Know Medicare marketing guidelines—e.g., Medicare does not call to ask for sensitive personal information and forbids unsolicited telemarketing, e-mail marketing, and sales of Medicare-related products and services.
  • Be wary of any entity that offers FREE prizes, meals, groceries, low-cost health care products, nutritional supplements or inexpensive vacations, or says that Medicare will pay for it. Watch for high-pressure sales tactics.
  • Consider making fraud awareness training an ongoing priority for your staff.

Guide for Inviting Outside Speakers to Your Organization

  • Do not allow speakers to collect Medicare numbers from attendees.
  • Request a biography from the speaker in writing before the presentation.
  • Check references for agencies or organizations; ask about them in your senior network; and check out potential speakers.
  • Do not allow a “sales pitch.”

How Your Senior Medicare Patrol (SMP) Can Help

The local SMPs are ready to provide Medicare beneficiaries with the information they need to PROTECT seniors from Medicare errors, fraud and abuse; DETECT potential errors, fraud, and abuse; and REPORT their concerns. SMPs use trained senior volunteers to help educate and empower older adults in the fight against health care fraud. The local SMP can help beneficiaries with questions, concerns or complaints about potential fraud and abuse issues. It also provides information and speakers for your facility.

 

For assistance, call the Texas SMP program at 713-341-6184 or 1-888-341-6187.

For more information or to locate your state SMP, visit www.smpresource.org.
Supported by grant number 90NP0001/01 from the U.S. Administration on Aging (AoA), Department of Health and Human Services.

 

welcome to medicare seminar may 23 flyer

Welcome to Medicare! Free Seminar

welcome to medicare seminar flyer

Learn the differences between types of Medicare coverage, prescription drug coverage, Medicare Advantage, and more at the Welcome to Medicare seminar. Guest speaker is Sheryl Schroeder, Public Affairs Specialist at the Social Security Administration – Dallas Region.

If you have Medicare and are lost when it comes to your coverage, or if you are looking to enroll and don’t know where to start, this seminar is for you! The event will be held on May 23, 10 A.M. to noon, in Conference Room D9 in the Central Texas Council of Governments building, located at 2180 N. Main Street in Belton, TX.