#USA #Albany #Genetic Testing #Medicare Fraud #StateWide Council

Understanding Genetic Testing Scams

In the ever-evolving landscape of healthcare fraud, the New York StateWide Senior Action Council (StateWide) has spotlighted genetic testing scams as the Medicare Fraud of the Month. Operating in the realm of healthcare and patient protection, this initiative focuses on safeguarding the rights and health of seniors across New York State. The alarming increase in scams targeting Medicare beneficiaries, particularly involving unnecessary genetic testing, has prompted StateWide to take action.

What Are Genetic Testing Scams?

Genetic testing scams typically involve deceptive practices where seniors are misled into providing their Medicare information under the pretext of receiving “free” or “no-cost” genetic testing. These tests might claim to screen for conditions like autoimmune diseases, cancer, dementia, or even pharmacogenetic responses but are often conducted without proper medical necessity. Maria Alvarez, the Executive Director of StateWide, explains that scammers trick beneficiaries into thinking they require these tests, often leading to significant fraudulent charges against Medicare.

Mechanisms of Deception

The modus operandi of these scammers is both clever and insidious. They may entice seniors at health fairs, senior centers, or through unsolicited phone calls, offering cheek swabs or other testing kits. Notably, the following tactics are common:

1. Free Tests: A company claims to provide genetic tests that are free or covered entirely by Medicare without any doctor’s order.
2. Telemedicine Consultations: Scams may involve dubious telemedicine consultations with unidentified doctors who order unnecessary tests.
3. Unexpected Charges: Beneficiaries often find charges for genetic tests they never requested on their Medicare Summary Notices (MSN) or Explanation of Benefits (EOB).
4. Pharmacogenetic Testing: Sometimes, beneficiaries receive bills for pharmacogenetic tests that don't pertain to any prescribed medications.
5. Direct Requests for Medicare Numbers: Scammers may approach individuals at public events, requesting their Medicare information under false pretenses.

Protecting Yourself from Scams

In light of these alarming practices, StateWide has issued several guidelines to help beneficiaries protect themselves:

• - Always consult your primary care physician before accepting any tests or procedures.
• - Be wary of services that promise free testing without a formal order from your doctor.
• - If Medicare denies coverage for a test, you might be liable for the costs, often averaging between $9,000 to $11,000.
• - Regularly review your MSN and EOB for any unfamiliar charges or services that you did not receive.
• - If approached by someone asking for your Medicare number, consider it a red flag.

Reporting Suspected Fraud

StateWide encourages any Medicare beneficiary who suspects fraud to report it immediately. The Medicare Senior Patrol (SMP) in New York State operates a hotline at 800-333-4374 for reporting fraudulent activities. StateWide has trained counselors available to assist beneficiaries in navigating these challenges and ensures that individuals know where to report any suspicious activities.

Conclusion

The ongoing economic impacts from Medicare fraud, estimated to cost taxpayers over $60 billion annually, highlight the urgency of public awareness and education regarding healthcare scams. The recruitment of individuals into these schemes not only poses a risk to financial security but can also lead to compromised health due to unnecessary medical procedures.

By illuminating the dangers of genetic testing scams, organizations like the New York StateWide Senior Action Council play a crucial role in protecting vulnerable populations from exploitation in the healthcare system. If you or a loved one is a Medicare beneficiary, vigilance and education are your best defenses against fraud.

For more information and resources, visit www.nysenior.org.