Jewish Family Services of Middlesex County (32 Ford Avenue, Milltown, NJ 08850, 732-777-1940) is a holder of a grant from the Administration for Community Living for the Senior Medicare Patrol of New Jersey (SMP) program. The mission of the SMP program is to empower and assist Medicare beneficiaries, their families and caregivers to prevent, detect and report health care fraud, errors and abuse through outreach, counseling and education.

Over the last several years, genetic testing has mushroomed into a huge scam.

First, we have to ask ourselves what does Medicare cover when it comes to genetic testing? Genetic testing is a Medicare-covered service, but only in a very limited number of cases. With so much interest in genetic tests as early warning systems for cancer, it makes sense that beneficiaries and others would wonder if Medicare covers genetic (or DNA) testing as a screening and prevention benefit. The answer, with one exception, is no. The exception is for the Cologuard™ test to screen specifically for colorectal cancer.

There are medical diagnoses relating to some types of cancers requiring chemotherapy, some forms of inherited cardiac disease and some types of psychiatric treatment with drugs that may be covered by Medicare. This coverage is only when the patient has one of a relatively small list of diagnoses. In these instances, the testing must be ordered by a physician who is treating the patient for one of these problems.

The SMP of New Jersey is concerned that many Medicare beneficiaries are being approached at senior centers, community centers and health fairs to provide their Medicare information and to provide a cheek swab to be genetically tested. Many of these tests are being touted as “preventive services,” which they are not.

Examples of genetic testing fraud:

A company offering you “free” testing without a treating physician’s order and then billing Medicare. These tests go by many names and claim to test for many things, such as:

• Cancer screening/test
• DNA screening/test
• Heredity cancer screening/test
• Dementia screening/test
• Parkinson’s screening/test
• Pharmacogenomics-medication metabolization

With the proliferation of these tests, the U.S. Department of Health and Human Services, Office of Inspector General, has issued a fraud alert concerning genetic testing. The alert reads as follows:

“The U.S. Department of Health and Human Services Office of Inspector General is alerting the public about a fraud scheme involving genetic testing.

“Scammers are offering Medicare beneficiaries cheek swabs for genetic testing to obtain their Medicare information for identity theft or fraudulent billing purposes. Fraudsters are targeting beneficiaries through telemarketing calls, booths at public events, health fairs, and door-to-door visits.

“If a beneficiary agrees to genetic testing or verifies personal or Medicare information, a testing kit is sent even if it is not ordered by a physician or medically necessary.

Protect Yourself

• If a genetic testing kit is mailed to you, don’t accept it unless it was ordered by your 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.
• Be suspicious of anyone who offers you free genetic testing and then requests your Medicare number. If your personal information is compromised, it may be used in other fraud schemes.
• A physician that you know and trust should approve any requests for genetic testing.
• Medicare beneficiaries should be cautious of unsolicited requests for their Medicare numbers. If anyone other than your physician’s office requests your Medicare information, do not provide it.
• If you suspect Medicare fraud, contact the HHS OIG Hotline. Phone: 1-800-447-8477 (1-800-HHS-TIPS.)”

Should a beneficiary in New Jersey become aware of any such fraud concerning genetic testing, we highly encourage them to call the SMP of New Jersey at 732-777-1940 or the hotline at 877-SMP-4359. Remember, Medicare fraud costs all taxpayers money and takes away funds that would be available to all Medicare beneficiaries for legitimate, medically necessary, Medicare services.

By Charles Clarkson, Esq.

Charles Clarkson, Esq. is the project director, Senior Medicare Patrol of New Jersey, at Jewish Family Services of Middlesex County.