Genetic Testing Fraud

Genetic Testing Fraud

Scammers are offering Medicare beneficiaries cheek swabs for genetic testing to obtain their Medicare information for fraudulent billing purposes or possibly medical identity theft. Genetic testing fraud occurs when Medicare is billed for a test or screening that was not medically necessary and/or was not ordered by a beneficiary’s treating physician. 

Here are several ways genetic testing is advertised: 

- Cancer screening/test               - DNA screening/test
- Hereditary cancer screening/test               - Dementia screening/test
- Pharmacogenetics (medication metabolization)       - Parkinson’s screening/test

Report potential genetic testing fraud, errors, or abuse if:

  • A company offers you “free” or “at no cost to you” testing without a treating physician’s order and then bills Medicare.
  • A company uses “telemedicine” to offer testing to you over the phone and arranges for an unrelated physician or “teledoc” to order the test
  • You see on your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB): 
    • Charges (usually thousands of dollars) for a broad range of genetic tests that you did not request or possibly even receive
    • Charges for pharmacogenomic tests (to determine how you metabolize drugs) for drugs that do not apply to you
  • A company requests your Medicare number (or possibly driver’s license) at health fairs, senior centers, assisted living facilities, malls, farmers markets, parking lots outside retail stores, home shows, or church-sponsored wellness events

To learn more about tips related to genetic testing fraud, click here
To learn how to read you Medicare Summary Notice (MSN) and Explanation of Benefits (EOB), click here.


Cardiovascular Genetic Testing Fraud

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

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                - Hereditary cardiovascular profile

Report potential cardiovascular genetic testing fraud, errors, or abuse if:

  • A company offering you “free” or “at no cost to you” testing without a treating physician’s order and then billing Medicare.
  • A company using “telemedicine” to offer testing to you over the phone and arranging for an unrelated physician or “teledoc” to order the tests.
  • Billing Medicare (usually thousands of dollars) for a broad range of cardiac genetic tests that you did not request or possibly even receive.
  • A company calls you stating your doctor or cardiologist requested that you have the testing done and they will send you a testing kit.

To learn more about tips related to cardiovascular genetic testing fraud, click here
To learn how to read you Medicare Summary Notice (MSN) and Explanation of Benefits (EOB), click here.

Report Suspected Fraud

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


SMP Consumer Fraud Alert Resources 

SMP Resources

OIG Fraud Alert Resources

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