The Missouri Senior Medicare Patrol (SMP) has issued an advisory about the most recent genetic testing fraud trend – cardiovascular genetic testing.
SMP says scammers are offering Medicare beneficiaries genetic testing cheek swabs to obtain their Medicare information for fraudulent billing purposes or possibly medical identity theft.
“The SMP is hearing reports of scammers calling Medicare beneficiaries, claiming their cardiologist wants them to have this test and offering to send a kit. Really the cardiologist made no such request,” said Rona McNally, Director of the Missouri Senior Medicare Patrol (SMP). “Their goal is not to help the beneficiary; it’s to get Medicare information, which scammers can use to bill Medicare for medically unnecessary genetic testing.”
Here are several ways cardiovascular genetic testing is advertised:
•Cardio/cardiac genetic screening/test;
•Cardiovascular genetic screening/test;
•Comprehensive cardiovascular panel;
•Comprehensive cardiomyopathy NSG;
•Cardiovascular disease genetic kit; and
•Hereditary cardiovascular profile.
“Not only is this a waste of much-needed Medicare dollars, the repercussions of falling for a scam of this nature can be devastating. If Medicare denies a cardiovascular genetic test claim, a beneficiary might be responsible for the entire cost of the test: The average cost is $9,000 to $11,000,” McNally said.
Cardiovascular genetic testing is covered by Medicare when the test is medically reasonable and necessary, when it is ordered by a treating physician, and when a treating physician orders the test as a diagnostic service and uses the results to manage the patient’s condition.
To stop cardiovascular genetic testing fraud:
•Be sure your doctor has assessed your condition. Although Medicare covers many genetic tests to detect heart disease, these tests do not predict or screen for cardiovascular disease (aka the diseases that affect the heart or blood vessels).
•Do not give out your personal information to anyone who calls you and claims that your cardiologist has requested cardiovascular testing.
•Do not give out your personal information or accept screening services from anyone at a community event, local fair, farmers’ market, parking lot or any other public event.
•Always read your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB). The words “gene analysis,” “molecular pathology,” or “laboratory” may indicate questionable genetic testing has occurred.
•If you received a cardiovascular genetic testing kit or test that was not medically necessary, report your concerns about billing errors or possible fraud and abuse to the Missouri SMP by calling 1 (888) 515-6565.
The Senior Medicare Patrol (SMP) can provide older adults with information to protect themselves from Medicare fraud, errors and abuse; detect potential fraud, errors and abuse; and report their concerns. The SMP helps educate and empower Medicare beneficiaries in the fight against healthcare fraud.