Yes, we all would love to know more about our pasts … some from a medical necessity and others just from plain curiosity. Unfortunately, genetic testing is one of the newer “gotcha” identity theft hacks. The U.S. Department of Health and Human Services of Inspector General has just alerted the public about this new fraud scheme.
What is Genetic Testing?
According to the U.S. National Library of Medicine, genetic testing is a voluntary medical test “that identifies changes in chromosomes, genes, or proteins. The results of a genetic test can confirm or rule out a suspected genetic condition or help determine a person’s chance of developing or passing on a genetic disorder.” With more than 1,000 genetic tests currently in use, genetic testing labs are sprouting up all over the country, and in some circumstances, health insurers now pay for the testing. For example, the Centers for Medicare and Medicaid Services pays for next-generation sequencing for people with advanced cancer or a family history if the test is medically necessary and ordered by a treating physician. These tests may cost $10,000 or more.
How Does Genetic Testing Fraud Happen?
Genetic testing fraud occurs when, in this case, Medicare is billed for a test or screening that was not medically necessary and/or was not ordered by a treating physician. For example, Mr. Smith, a retiree, attended a county fair and stopped by a booth offering “free genetic testing.” Not realizing that a treating physician’s orders would be needed for Medicare to cover the cost of the test and being naturally curious about his family’s risk of cancer, Mr. Smith provided his Medicare personal identifying information to the booth worker prior to getting his cheek swabbed. In some cases, sample kits are mailed to the victim. He was then told to expect test results in about three weeks. Medicare was billed for the test and denied the claim. Mr. Smith was then charged the full amount of the test and likely never received his results. Basically, Mr. Smith’s scammer found a laboratory willing to split the profit from the testing once the DNA samples were in hand.
How Can I Prevent This?
– If a genetic test is mailed to you unsolicited, do not accept it. Just write ‘return to sender’ on the envelope and send it back.
– Understand that there are schemes that say genetic testing is free. Although it may falsely appear as a no cost test, realize that there are no free genetic tests. Someone always has to pay.
– Only a physician that you know (and trust) should be discussing genetic testing with you or ordering it.
– If someone you do not know asks for your health insurance or Medicare information, do not provide it. Only provide this type of information in person at your physician’s office.
– Be aware that anytime your personal information is compromised, it may be used in other fraud schemes. Closely monitor your credit report and make sure your identity theft resolution services coverage is current.
If you suspect genetic testing fraud, please contact the HHS OIG (U.S. Department of Health and Human Services – Office of Inspector General) hotline at 1.800.HHS.TIPS or email firstname.lastname@example.org immediately. Not sure what to do or have concerns about this topic? Contact us day or night. We are always open for you.