The Missouri SMP (Senior Medicare Patrol) wants to alert you to the latest genetic testing fraud trend – cardiovascular genetic testing.
Scammers are offering Medicare beneficiaries genetic testing cheek swabs to obtain their Medicare information. The scammers then use the information for fraudulent billing purposes or possibly medical identity theft. The scammers sometimes call the beneficiaries and tell them that their cardiologists have ordered the genetic tests. However, no such orders have been placed.
Sometimes the testing is called cardio/cardiac genetic screening/test; cardiovascular genetic screening/test; comprehensive cardiovascular panel; comprehensive cardiomyopathy NSG; cardiovascular disease genetic kit; or hereditary cardiovascular profile.
If Medicare denies a cardiovascular genetic test claim, you might be responsible for the entire cost of the test, as much as $11,000. Cardiovascular genetic testing is covered by Medicare when the test is medically reasonable and necessary, when it is ordered by a treating physician, and when a treating physician orders the test as a diagnostic service and uses the results to manage the patient’s condition.
To help prevent fraud, be sure that your doctor has ordered the tests you are receiving. Don’t give out personal information on the phone or accept screening services from anyone at a community event, local fair, farmers’ market, parking lot, or any other public event. Always read your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB). The words “gene analysis,” “molecular pathology,” or “laboratory” may indicate questionable genetic testing has occurred. As always, report suspected health care fraud or abuse to the Missouri SMP (Senior Medicare Patrol) at (888) 515-6565. The Missouri SMP empowers and assists Medicare beneficiaries to prevent, detect and report healthcare fraud, errors, and abuse.
This project was supported, in part by grant number 90MPPG0040, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.