Genetic Testing Fraud

Genetic testing fraud occurs when Medicare is billed for a test or screening that was not medically necessary and/or not ordered by a beneficiary’s treating physician.  

What are examples of genetic testing fraud?

  • A company offering you “free” testing without a treating physician’s order and then billing Medicare. These tests go by many names and claim to test for many things. Here are some examples of ways you may see this advertised:
    • Cancer screening / test
    • DNA screening / test
    • Hereditary cancer screening / test
    • Dementia screening / test
    • Parkinson’s screening / test
    • Pharmacogenomics – medication metabolization
  • A company providing a test or screening that you never requested or that you do not need
  • A company billing Medicare for screening services that are not covered by Medicare or for screenings that do not apply to you
  • A company requesting your Medicare number at a community event, a local fair, a farmer’s market, a parking lot, and or any other event

What happens if Medicare denies the genetic test claims?

  • You could be responsible for the entire cost of the test! The average is $9,000-$11,000.

What can you do to stop genetic testing fraud?

  • Be sure your doctor has assessed your condition. Although Medicare covers many genetic tests for diagnostic use, it only covers one preventative genetic test to screen for cancer.
  • Do not give out your personal information or accept screening services from someone at a community event, a local fair, a farmer’s market, a parking lot, and or any other 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 cheek swab or a screening that was not medically necessary, report your concerns about billing errors or possible fraud and abuse to your local SMP.

Report Fraud

To learn about reporting potential Medicare fraud, errors, or abuse, click here.

More Information