Be on the alert for aggressive marketing emails and online ads, meant to seduce and defraud Medicare recipients and their beneficiaries, which promise to answer the simple question: Do you qualify for Medicare’s genetic cancer screening tests?
Criminal opportunists are attempting to gather personally-identifying information to commit identity theft and financial fraud by posing as medical testing laboratories offering saliva tests to identify inheritable genetic mutations. Beware of any such lab that has not received FDA approval!
Data thieves are taking advantage of a new scam that is gaining momentum on social media and through targeted direct marketing.
In March 2018, the Centers for Medicare & Medicaid Services (CMS) approved coverage of Next Generation Sequencing tests for Medicare patients with cancer. Medicare would begin covering genetic evaluation of cancer by FDA-approved tests.
Seema Verma, CMS administrator, said in a statement at that time:
“We want cancer patients to have enhanced access and expanded coverage when it comes to innovative diagnostics that can help them in new and better ways.”
Genomic and molecular cancer tests that do not have FDA approval may be declined coverage, a decision made by U.S. regional Medicare administrative contractors. The problem is that these brand-new tests are pricey and the providers are few and far between so far.
For example, Foundation Medicine charges $5800 for its FDA-approved assay called FoundationOne CDx™, which they billed as “the First and Only Comprehensive Genomic Profiling Test for All Solid Tumors Incorporating Multiple Companion Diagnostics.”
Actually, the preceding fall, in November 2017, the FDA first approved a tumor scan called MSK-IMPACT from Memorial Sloan Kettering Cancer Center in New York which “can scan tumor samples for 468 different cancer-associated mutations or alterations.”
The cost of genetic testing for disease assessment can be as high as $10,000, according to STAT news, and “With that kind of money in play, opportunists see an opening.”
Some criminals are posing as lab representatives and offering a cheek swab for genetic testing as part of a “free” health screening at events such as local health fairs to get Medicare beneficiaries’ information for identity theft or fraudulent billing purposes.
Bogus third parties are offering payment to agents who help Medicare beneficiaries complete genetic tests. An example solicitation to persuade a health insurance business by offering DNA cancer testing says the “invaluable service” will get agents “on the front lines” and that it’s easy to “start promoting” with the swab test program readily available for purchase.
The deceptive third-party company appeals to health insurers’ sense of the common good (in addition to more sales profits) to sell their fraudulent consumer data collection kits:
“It’s important to communicate to your clients that the tests are funded by The Centers for Medicare and Medicaid Services so there is absolutely no cost to the Medicare Beneficiaries. You will be providing your community with an invaluable service, helping to eradicate cancer.”
One such website began their attempt to defraud with the following two questions:
Do you currently have Medicare coverage?
Do you have personal or family history of cancer?
A ‘yes’ answer to both questions yields this results screen:
“Good News! It looks like Medicare should cover your genetic cancer screening!”
Next step: “Request your test.”
This is where the fraudsters collect enough personal information about you to make your life miserable:
Name, gender, date of birth, email, phone, address, and insurance/billing information.
They also ask a few gratuitous questions about your and your family’s cancer history, other medications you might be taking, and if you’ve ever had a genetic cancer screening test before, to make you believe their purpose is legitimate.
The Agent Survival Guide advises beneficiaries to “never give out their Social Security, Medicare/health plan numbers or banking information to someone they do not know.”
The American Society of Clinical Oncology (ASCO) encourages anyone interested in getting a claims reimbursement for genomic testing to go through a licensed healthcare professional:
“Most health insurance plans will cover the cost of genetic testing when recommended by a physician. However, all coverage and reimbursement is subject to Medicare, Medicaid, and third-party payer benefit plans. Therefore, ASCO strongly encourages you to verify with the patient’s insurer to understand what type of services will be covered.”
Health insurance clients should only agree to a lab test under their doctors’ orders. Insureds can call the customer service number on the back of their ID cards to discuss coverage or other concerns.
Health insurance agents should be wary of anyone who offers payment for referrals of medical services covered by Medicare. Health screenings, including genetic testing, are prohibited at health insurance marketing events because they are opportunities to “cherry-pick” the best or most desirable consumer data.
The Office of Inspector General of the Department of Health and Human Services (OIG) updated its fraud alert for the genetic testing scam on June 3, 2019.
If you suspect Medicare fraud, contact the HHS OIG Hotline.