The Office of the Inspector General for Health and Human Services (OIG) recently issued a Fraud Alert to the public identifying a fraud scheme involving genetic testing. To reduce fraud and abuse in federal health care programs, including Medicare and Medicaid, the OIG actively investigates potentially fraudulent schemes that are used to obtain money from these programs and, when appropriate, issues alerts that identify practices that are potentially fraudulent. This Alert confirms the OIG’s long-held concerns about fraudulent schemes involving genetic testing.
The Alert, updated on June 3, 2019, indicated that individuals and/or entities are offering Medicare beneficiaries cheek swabs for genetic testing, with the nefarious intent of obtaining their Medicare information for use in fraudulent conduct. These scammers may target beneficiaries through telemarketing calls, health fairs and even door-to-door visits. The genetic testing is not ordered by a physician and is likely not medically necessary or even allowable under applicable state law.
The Alert recommends that Medicare beneficiaries take the following precautions:
- If a genetic testing kit is mailed to you, do not accept it unless it was ordered by your physician; Refuse the delivery or return it to the sender. Keep a record of the sender’s name and the date you returned the items.
- Be suspicious of anyone who offers you free genetic testing and then requests your Medicare number. If your personal information is compromised, it may be used in other fraud schemes.
- A physician that you know and trust should approve any requests for genetic testing.
- Medicare beneficiaries should be cautious of unsolicited requests for their Medicare numbers. If anyone other than your physician’s office requests your Medicare information, do not provide it.
- Report any suspected Medicare fraud to HHS OIG
Pharmacies, prescribers, and manufacturers should also take note of any future OIG and CMS guidances and stay informed about the relevant laws and regulations concerning genetic and pharmacogenetic testing. All parties involved in the marketing, prescribing and reporting of genetic and pharmacogenetic testing, billed to Federal healthcare programs, should review their practices. A thorough internal review, combined with the development of a set of robust standard operating procedures, is a valuable process to avoid future enforcement action.
Frier Levitt has a long history of counseling pharmacies, prescribers, manufacturers, and marketers on proper practices related to genetic and pharmacogenetic testing. We assist these clients in reviewing their marketing communications and evaluating their procedures for compliance with applicable federal and state laws and regulations. Contact Frier Levitt to speak to an attorney.