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State Warns of Medicare Scam

August 19, 2019, 3:35 PM HST
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A new scam popping up across Hawai‘i and the nation involves genetic testing company representatives offering “free” genetic tests to Medicare beneficiaries. These tests can also be referred to as DNA screenings, cancer screenings and hereditary testing, to name a few.

The representatives go to senior centers, senior housing, health fairs and even parking lots to convince people to let them take a cheek swab for testing. They advertise on TV and online. They promise that the results will help recipients avoid diseases or find the right medications. All they ask for in return is the person’s Medicare number, said a release from the Hawai‘i Executive Office of Aging.

While this may sound harmless, in reality it is dangerous, the release continued.

“These companies can steal people’s medical identity and falsely bill Medicare, draining the system of needed funds,” said Senior Medicare Patrol (SMP) Hawai‘i Program Manager Kaipo Cullen. “Tests ordered under these circumstances are unnecessary and could lead to confusion about someone’s health condition.”

Because confusion exists regarding Medicare’s coverage for genetic tests for cancer and other conditions, the Office of Inspector General (OIG) released a fraud alert on the topic. It advises the public to be suspicious of anyone who offers free genetic testing and then requests their Medicare number.

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The OIG’s fraud alert also states that only a trusted physician should approve any requests for genetic testing. In fact, federal regulations state that diagnostic tests must be ordered by the physician who is treating the beneficiary—in other words, the person’s own doctor.

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“A doctor who has never met or examined a patient, often hired by a genetic testing company, should not be signing off on any tests,” said Cullen. “That’s a red flag.”

Medicare beneficiaries should:

  • Refuse to give out their personal information or accept screening services, including a cheek swab, from someone at a community event, a local fair, a farmer’s market, a parking lot and/or any other large event.
  • Go to their own doctor to assess their condition, not a doctor on the phone they’ve never met from a company they don’t know.
  • Always read their Medicare Summary Notice (MSN) or Explanation of Benefits (EOB). The words “gene analysis” or “molecular pathology” as service codes may indicate questionable genetic testing.
  • Refuse the delivery of any genetic testing kit that was not ordered by their physician.
  • Be suspicious of anyone who offers free genetic testing and then requests their Medicare number. If their personal information is compromised, it may be used in other fraud schemes.
  • Contact their local SMP for help. SMPs empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect and report health care fraud, errors and abuse.

The Senior Medicare Patrol (SMP) is ready to provide information needed to protect yourself from Medicare fraud, errors and abuse; detect potential fraud, errors and abuse; and report your concerns.

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SMPs help educate and empower Medicare beneficiaries in the fight against healthcare fraud. Your SMP can help you with your questions, concerns or complaints about potential fraud and abuse issues. It also provides information and educational presentations. To contact SMP Hawai‘i, call toll free at 1-800-296-9422.

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