- Randy Hutchinson is president and CEO of the Better Business Bureau of Mid-South.
The headline of an article I read said that genetic testing fraud could be the next big problem in American health care.
Considering that a lab owner was sentenced to 27 years in prison last year for defrauding Medicare of $187 million through genetic testing, it’s scary to think that the numbers could get much worse.
Minal Patel of Atlanta owns LabSolutions, which has joined Medicare for complex genetic testing.
The Justice Department said he conspired with patient brokers, telemedicine companies and call centers to contact Medicare beneficiaries and falsely claim that Medicare would pay for expensive cancer genetic tests.
If Medicare beneficiaries agreed to be tested, Patel paid kickbacks and bribes to brokers to find telemedicine doctors who would authorize the tests. Doctors approved these tests even though they did not treat Medicare beneficiaries, often never spoke with them, and did not evaluate the medical necessity of the tests.
Over the three-year period, Patel billed Medicare $463 million; it paid out $187 million. He personally received $21 million.
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Federal officials are pursuing cheating
Three people were arrested in Texas for running a similar scheme through a company called ApolloMDx.
They offered illegal kickbacks, purchased recipient information from marketers, and purchased genetic testing orders from doctors.
Some doctors falsify diagnoses to make patients appear eligible for genetic testing when in fact they are not. ApolloMDx also changed the service dates for test orders to make it appear as if multiple DNA samples were collected on different dates in order to bill for additional services.
These scammers charged Medicare $142 million for genetic testing. When they were arrested, Texas authorities and the FBI seized sports cars, a sailboat and property worth a total of $7.1 million.
The FBI agent working on the Patel case said deception, kickbacks and bribes will not be tolerated when providing legitimate genetic testing and telemedicine services to patients in need. Our message to those who commit Medicare fraud and steal from American taxpayers is clear: You will be caught and held accountable.
Five tips to protect yourself from scams
Fraudsters also target Medicare beneficiaries through public events, health fairs and door-to-door booths, the U.S. Department of Health and Human Services inspector general said. Victim information may also be used to commit identity theft. The inspector general warns that if Medicare denies a claim for genetic testing, Medicare beneficiaries could be on the hook for the full cost of the test, which could be thousands of dollars.
The Inspector General offers the following recommendations to protect yourself:
- If a genetic testing kit is mailed to you, do not accept it unless your doctor orders it. Refuse delivery or return it to sender. Record the sender’s name and the date you returned the item.
- Be suspicious of anyone who offers you a free genetic test and then asks for your Medicare number. Your personal information may be used in other fraudulent schemes.
- A doctor you know and trust should evaluate your condition and approve any genetic testing request.
- Medicare beneficiaries should be cautious about unsolicited requests for Medicare numbers. If anyone outside your doctor’s office asks you for your Medicare information, do not provide it.
- If you suspect Medicare fraud, please contact the HHS OIG Hotline.
Randy Hutchinson is president and CEO of the Better Business Bureau of Mid-South.
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