You may have seen it on TV or heard it on the radio. You may have received a card in the mail, a flyer dropped off at your doorstep, or hidden under the wipers in your car.
DNA test. Not the type to help you find your long lost cousins and see what nationalities are in your family history.
We’re talking about the type of genetic test that can help diagnose diseases so you can anticipate your health risks.
For the most part, these tests are not covered by insurance, and there is a spike in scammers offering tests to Medicare beneficiaries with fraud in mind, according to the US Department of Health and Human Services ( HHS).
He said many tests are touted as preventative care, but there is an ulterior motive.
“Scammers are offering Medicare beneficiaries cheek swabs for genetic testing to obtain their Medicare information for the purposes of identity theft or fraudulent billing,” HHS said on its website. “Scammers target beneficiaries through telemarketing calls, booths at public events, health shows, and home visits.”
Some seniors inadvertently help scammers by not recognizing that these services are usually not covered, and then scammers try to trick Medicare into paying the bills. It often works.
What does health insurance cover?
Genetic testing is a service covered by Medicare, but only in a very limited number of cases, said Charles Clarkson of the New Jersey Master Medicare Patrol, a group of volunteers trained by the federal government to detect Medicare fraud.
“With as much interest in genetic testing as cancer early warning systems, it makes sense for beneficiaries and others to question whether Medicare covers genetic (or DNA) testing as a screening and prevention benefit. “, did he declare. “The answer, with one exception, is no. “
The exception is that the Cologuard test can specifically screen for colorectal cancer, Clarkson said.
He said there are tests linked to certain types of cancers, certain forms of inherited heart disease, and certain types of psychiatric treatments that may be covered by Medicare.
But the key? Coverage is only available when the patient has a diagnosis from a relatively small list. In these cases, the test should be ordered by a doctor who is treating the patient for one of these problems, he said.
“Unfortunately, many of these services can be billed as being prescribed by a doctor who has never seen the patient and has no knowledge of the patient’s history,” Clarkson said. “Therefore, Medicare actually paid for these tests. “
Among the tests offered: cancer screening / testing; DNA screening / test; Heredity cancer screening / test; dementia screening / testing; Parkinson’s disease screening / testing and pharmacogenomic-drug metabolism.
It is outright fraud, costing all of us money, lining the pockets of crooks, and draining funds that could be used for legitimate health insurance bills.
Here are some tips for HHS seniors:
· If a genetic test kit is mailed to you, do not accept it unless ordered by your doctor. Decline the delivery or return it to the sender. Keep track of the name of the sender and the date you returned the items.
· Be wary of anyone who offers you free genetic testing and then asks for your Medicare number. If your personal information is compromised, it can be used in other fraud schemes.
· A doctor you know and trust should approve any request for genetic testing.
· Medicare beneficiaries should be wary of unsolicited requests for their Medicare numbers. If someone other than your doctor’s office asks for your Medicare information, do not provide it.
· If you suspect Medicare fraud, contact the HHS OIG hotline at (800) 447-8477. Senior Medicare Patrol of New Jersey also wants to know. Call them at (877) SMP-4359.
If you think your Medicare number has been compromised, you can call Medicare and they can issue you a new number, just like a credit card.
About the Medicare Master Patrol
Bamboo column featuring the main Medicare patrol in this space a few years ago, but as Medicare fraud continues to grow, we want to make sure you know about its services.
For starters, it’s free.
Each state, Guam, Puerto Rico and the U.S. Virgin Islands have a primary health insurance patrol, Clarkson said.
“Our mission is to empower and help Medicare beneficiaries, their families and caregivers to prevent, detect and report healthcare fraud, errors and abuse through education, counseling and education, ”he said.
The organization gives presentations to groups to educate participants about Medicare fraud, then it will work one-on-one with beneficiaries to determine if there is fraud or abuse related to Medicare claims.
“In case of suspicion of fraud or abuse, [Senior Medicare Patrols] make referrals to the appropriate state and federal agencies for further investigation, ”Clarkson said.
If you would like to volunteer, call (732) 777-1940. Volunteers will undergo a background check and undergo training, which can be done online.
Have you been scoffed at? Contact Karin Price Mueller at [email protected]. Follow her on Twitter @KPMueller. Find Bamboo on Facebook. Mueller is also the founder of NJMoneyHelp.com. Stay informed and subscribe NJMoneyHelp.com‘s weekly electronic newsletter.