Medicare Scams Surround Unnecessary Genetic Testing

Published 03/07/2018

Several False Claims Act lawsuits have been filed against individuals and laboratories that are alleged to have lured patients into having unnecessary genetic testing. Much of this activity happens at health fairs, ‘ice cream socials’ and other events that draw crowds small and large to a single venue.

How it works:  lab representatives ‘swab’ the insides of patients’ cheeks and promise that the results will show possible negative interactions to medicines the patients are taking.  Often the lab staff will give out free vouchers or gifts to participate.  They ask seniors for their Medicare numbers and say they will send the results to the patients’ doctors.  Some individuals even offer cash.  They say that Medicare will cover the services and that the patients don’t need to worry about a thing.

This could not be further from the truth.

Medicare covers specific genetic testing when it is medically reasonable and necessary for the diagnosis or treatment of the beneficiary.  Genetic testing must be ordered by a physician or practitioner, and labs must keep the orders in a patient’s case file.  In these situations, when audited, the labs can’t produce doctors’ orders that were never made, and Medicare has taken back money paid for suspect services.

Here’s an example of this scam in action:  Millennium Health (formerly called Millennium Laboratories) settled with the government to pay back $10 million to resolve allegations of submitting false claims for genetic testing, which was performed without orders or an assessment of the patients’ needs.   According to the Department of Justice, Millennium allegedly promoted unnecessary testing that ‘increased medical costs without serving patients’ real medical needs’, said U.S. Attorney Carmen M. Ortiz. 

At Railroad Medicare, our Benefit Integrity Unit (BIU) investigates cases and seeks to identify potential fraud or abuse.  The BIU looks for labs billing specific codes related to this type of testing, as well as for multiple tests by the same lab on the same date of service. 

If are concerned about a test you have had, or if you have questions about your Railroad Medicare coverage, you can call our Beneficiary Contact Center at 800-833-4455, or for the hearing impaired, call TTY/TDD at 877-566-3572. Customer Service Representatives are available Monday through Friday, from 8:30 a.m. until 7 p.m. ET. 

You also can contact us by mail at:

Palmetto GBA/Benefit Integrity
P.O. Box 1956
Augusta, GA 30999

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