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Fraud Alert: How to Avoid Genetic Testing Scam That Can Cost Thousands

September 18, 2019

Genetic testing has become so popular that your test might even qualify for a tax break. But when someone other than your doctor recommends it, keep your Medicare card in your wallet — it could be a scam.

Scam artists setting up booths at public events or health fairs, using telemarketing tactics or going door-to-door through your neighborhood are offering “free” genetic testing with a promise that it’s covered, no charge, by Medicare. They take your Medicare information and you take the test — usually a cheek swab, testing kit or in-person screening. Then Medicare, billed by the scammers, pays out enormous fees. But your claim could be denied if the test was not medically necessary, possibly leaving you with a financial hit.

How much?

• A woman living in a Florida retirement community was a victim of a scam that charged Medicare $21,000 for genetic testing for cancer. Medicare paid $8,000 to the testing laboratory, then the woman turned to Hartford HealthCare for genetic counseling at Hartford Hospital.
• A Texas couple tested at a Fort Lauderdale, Fla., arts festival received a Medicare bill for more than $18,000, according to a CBS report.
• A mentally disabled woman tested by someone going door-to-door in North Carolina was billed by Medicare for more than $21,000.

Genetic tests can help assess the risk for various diseases but usually cannot diagnose them. Among the diseases: Parkinson’s, late-onset Alzheimer’s, cancer, rare neurological conditions and Celiac disease.

“Only proceed with genetic testing with a  doctor or provider you know personally and who is willing to explain the meaning of your genetic testing results,” says John Neary, a licensed genetic counselor with the Hartford HealthCare Genetic Counseling & Testing Program. “Don’t proceed with  a genetic analysis offered ‘for free’ by company representatives with no medical training.”

The recent patient who was a scam victim, says Neary, didn’t even meet the medical criteria for a genetic test for cancer.

“She had no personal history of cancer,” he says. “Medicare never covers genetic testing for cancer risks for people with no personal history of cancer. So the genetic testing company must have lied to Medicare about why the testing was being done.”

The amount billed also pointed to a scam. Such testing by a reputable laboratory, says Neary, might cost $1,500 to $3,200. “Medicare was charged exorbitantly for this analysis,” he says.

In his evaluation of the patient’s situation, Neary found the testing incomplete and of questionable value. Most reputable DNA testing laboratories, he says, test for genetic risk factors using two methods: sequencing that determines information within a DNA molecule and deletion/duplication testing to see if large pieces of DNA are missing or extra.

“All reputable laboratories do both forms of this genetic analysis,” says Neary.

The fraudulent laboratory only performed the sequencing portion of the test.

The Department of Health and Human Services Office of Inspector General, in a recent fraud alert, said the scammers are also looking for Medicare information for identity theft.

Here’s how to protect yourself, says the federal agency:

• Only agree to a genetic test your doctor has ordered.
• Beware of anyone who offers a free genetic test, then asks for your Medicare number.
• If anyone other than you doctor’s office requests your Medicare information, do not provide it.

Always review your Medicare Summary Notice or Explanation of Benefits for keywords like molecular pathology, gene analysis or laboratory that can indicate questionable genetic sting, says the the Better Business Bureau.

If you or an elderly relative has received screening that wasn’t authorized by your doctor, report it to the Senior Medicare Patrol, operated in Connecticut by the State Unit on Aging. Call 1.800.994.9422.

To learn more about the Genetic Counseling and Testing Program at Hartford HealthCare, click here.