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“It seems like every day there is a new medical breakthrough to reduce mortality and prolong quality of life – new vaccines, pharmaceuticals, medical devices, or clinical laboratory tests, and screening procedures,” said Kathleen Pursell, AR SMP Program Director. “Unfortunately, many of the most exciting health care innovations are also the ones of greatest interest to unscrupulous con artists and scammers who target vulnerable seniors to fraudulently bill Medicare for medically unnecessary services or obtain sufficient personal information to steal the victim’s medical identity.”

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 Medicare beneficiary’s treating physician. Medicare strictly limits coverage for genetic screening tests, although it does cover many genetic tests that meet the criteria for diagnostic tests such as those used to treat cancer and other medical conditions. Nevertheless, the scammers claim that the testing they offer is covered by Medicare, and thus “free” to the beneficiary. If Medicare subsequently denies the claim, the beneficiary could be responsible for the entire cost of the test – which often totals around $10,000.

Offers are made through telemarketing calls, texts, or in-person at your front door. Scammers also frequent venues populated by seniors like health fairs, farmers’ markets, church-sponsored wellness events, malls, and senior centers and apartments. Con artists may provide gift cards or other giveaways to incentivize participation. Many use “fear factor” messaging to persuade seniors anxious to diagnose existing health concerns to accept too-good-to-be-true “free” tests to proactively identify future medical conditions.

“If you are a senior on Medicare or the caregiver of a Medicare beneficiary, ask yourself who picks up the tab for ‘free’ genetic testing because it could be you,” Pursell said. “As taxpayers who contribute to Medicare, we all foot the bill for health care fraud. However, if you agree to accept genetic testing and Medicare refuses to pay, the responsibility for that fraudulent bill could be yours alone.”

Here are some tips to protect yourself from Medicare genetic testing fraud:

Do not accept genetic testing services, including a cheek swab, from someone at a community event, a local fair, a farmer’s market, a parking lot, or any other large event.

Be suspicious of anyone claiming that genetic tests and cancer screenings are “free” or “covered by Medicare.” If a product or test is truly “free,” you will not have to provide your Medicare number.

If a genetic testing kit is mailed to you, don’t accept it unless it was ordered by your own physician. Refuse the delivery or return it to the sender. Keep a record of the sender’s name and the date you returned the items.

If you are interested in these tests, call your primary care provider for an assessment of your condition. If indicated, he or she can approve appropriate and indicated genetic tests that will be reimbursed by Medicare.

Don’t share your Medicare number. If anyone other than your physician’s office requests your Medicare information, do not provide it. Also, protect your Medicare card by treating it like a credit card, don’t give the number out.

Con artists often say they are calling from Medicare or another government agency, but Medicare will never call you to confirm your personal information and Medicare number, or ask questions about your personal health.

Always review your Medicare Summary Notice (Explanation of Benefits). The words “gene analysis” or “molecular pathology” may indicate charges for questionable genetic testing.

If you received a cheek swab or a screening test that was not ordered by a trusted provider or have any concerns about billing errors or possible healthcare fraud, call the Arkansas Senior Medicare Patrol toll free at (866) 726-2916.