Scammers are offering ‘free’ genetic tests to rip off Medicare

ZEPHYRHILLS, Fla. — Genetic testing can help unlock your health risks for certain diseases like cancer.

But can it also open you up to healthcare fraud?

Barbara Stetson said it started with a UPS package delivered to her Zephyrhills address. Inside the box was a cheek swab, test tube, and what looked like a legitimate lab order with Stetson’s personal information, including her Medicare number.

Not long after the delivery, Stetson said her phone rang.

She didn’t recognize the number.

“That was kind of spooky,” Stetson said. “I thought, what on Earth?”

She said the man on the phone claimed to be with the lab that sent the “free” test. He wanted to walk Stetson through how to take it and mail it back. Medicare would cover the cost, he told her.

But Stetson said it wasn't her physician listed on the lab order. Suspicious it was a scam, she contacted VERIFY.

THE QUESTION

Will Medicare ever offer “free” genetic testing not ordered through your doctor?

THE SOURCES

• AARP
• Centers for Medicare and Medicaid Services (CMS)
• Senior Medicare Patrol
• U.S. Department of Health and Human Services (HHS)
• U.S. Department of Justice

THE ANSWER

No, Medicare does not offer “free” genetic testing.

Tests must be ordered by your physician and deemed medically necessary.

WHAT WE FOUND

The U.S. Department of Health and Human Services Office of Inspector General has issued a fraud alert about genetic testing scams, warning to be suspicious of anyone offering “free” genetic testing through Medicare.

Scammers have also targeted victims at health fairs, senior centers, assisted living facilities, malls, farmers markets, parking lots outside retail stores, home shows and church-sponsored wellness events, where they offer to swab your cheek and test the sample to determine whether you have a genetic propensity for cancer, according to AARP and Senior Medicare Patrol, a grant-funded project of HHS and the U.S. Administration for Community Living (ACL).

Scammers are likely after your Medicare information for identity theft or fraudulent billing purposes. The claims they file in your name can amount to thousands of dollars.

Medicare will only cover genetic testing if it’s determined to be medically necessary and ordered by your doctor.

Federal investigators have uncovered cases where scammers have managed to skirt the rules by paying kickbacks to doctors willing to sign off on the tests without ever treating the patients. Labs then process the test and bill Medicare for reimbursement.

A Florida doctor was charged in federal court in 2019, accused of signing off on tests for patients in other states he never treated in exchange for payments up to $5,000 each month, according to the U.S. Attorney’s Office.

But what if Medicare denies payment for a genetic test that was fraudulently billed? Are beneficiaries the one left with the bill?

“[If] an investigation concludes that the person with Medicare was a victim and not a fraud participant, liability for cost tests would shift to the provider who committed the fraud,” a CMS spokesperson told 10 Tampa Bay.

To protect yourself:

• Don’t accept a genetic test kit mailed to you unless it was ordered by your physician.
• Be suspicious of anyone offering “free” genetic testing through Medicare.
• Always review your Explanation of Benefits (EOB) or Medicare Summary Notice (MSN) for any services you didn’t have or want.

If you suspect your Medicare number has been compromised, you can request a new one from the Centers for Medicare and Medicaid Services.

If you believe you are a victim of a scheme like this, you can contact the FBI at 1-800-CALL-FBI or contact the U.S. Department of Health and Human Services Office of the Inspector General at tips.HHS.gov or by calling 1-800-447-8477. Suspected fraud can also be reported to your local Senior Medicare Patrol, which you can locate by calling 1-877-808-2468 or visiting www.smpresource.org. 

Medicare beneficiaries should also contact Medicare at 1-800-MEDICARE.