DNA/Genetic testing schemes are on the rise!
Submitted By: Kirsten O’Donnell, MBA (Director of Communications, Area Agency on Aging for Southwest Florida)
NORTH FORT MYERS, FL – Each year, the Medicare program loses $60 billion to fraud. The best way to reduce this figure is to educate beneficiaries to identify potential Medicare fraud and unethical billing practices. DNA and Genetic testing schemes are a recently discovered pathway to Medicare fraud and abuse. The Area Agency on Aging for Southwest Florida and the SHINE/SMP (Serving Health Insurance Needs of Elders/Senior Medicare Patrol) Program have recently become aware of these genetic testing schemes here in Southwest Florida.
WHAT IS THE SCAM?
Older adults are being been targeted by companies promoting “free” genetic testing, cancer screening, or DNA testing. Elders are often approached by these companies at senior centers, housing complexes, and community events like health fairs. During an event, beneficiaries are asked to swab their cheek to collect a DNA sample, which will be sent to a lab for analysis.
Either at the time of the test or during a later follow-up call, the beneficiary is falsely told that testing will be covered by Medicare 100%. The company then asks for a Medicare number to process the claim. This scam is resulting in fraudulent charges and leaving many Medicare beneficiaries liable for significant charges.
In another variation of the scam, some Medicare beneficiaries are being contacted at home by phone and told that they will receive 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.
In neither of these examples are beneficiaries provide with the results of the tests, although screening has been billed to Medicare.
WHAT YOU NEED TO KNOW:
All diagnostic x-rays, laboratory tests, and other diagnostic tests must be ordered by the physician who is treating the beneficiary. Medicare only covers these tests when they are deemed “medically necessary.” To qualify as a Medicare-covered expense, diagnostic tests must be ordered a 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 considered reasonable and necessary, and are thus not covered.
Medicare only covers one genetic test to screen for a cancer: Cologuard, a colorectal cancer screening test available only by prescription. The posturing of any other genetic test as a Medicare-covered screening benefit (available for free no less) should send up a red flag.
SHINE is a program of the Florida Department of Elder Affairs and is operated locally through the Area Agency on Aging for Southwest Florida. Senior Medicare Patrols (SMPs) empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report heath care fraud, errors, and abuse through outreach, counseling, and education.
SHINE empowers seniors, their caregivers, and family members to make informed decisions about health care coverage. SHINE counselors can also help beneficiaries understand benefits available through Medicare, like preventive health care services. Additionally, SHINE counselors assist low-income Medicare beneficiaries with applying for cost-savings programs. As part of the national SMP program, counselors also educate beneficiaries to protect, detect, and report potential errors, fraud, and abuse with their Medicare coverage.
To receive help from SHINE, individuals may schedule appointments at designated SHINE counseling sites, attend enrollment events in their local communities, or arrange to speak with a trained SHINE counselor at 1-800-96-ELDER (1-800-963-5337). For a listing of SHINE counseling sites and enrollment events, please visit www.floridashine.org.
Currently celebrating its 40th year of service, Area Agency on Aging for Southwest Florida is a nonprofit organization serving Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota Counties. AAASWFL is the state’s designated Aging and Disability Resource Center for Southwest Florida. The organization is committed to connecting older adults and adults with disabilities to resources and assistance for living safely with independence and dignity. In addition to SHINE, supported programs include the Elder Helpline, health and wellness programming, and elder abuse prevention education.
More information is available at www.aaaswfl.org or by calling the toll-free Helpline at 866-413-5337 (866-41-ELDER).