Warning: Many insurance carriers have recently issued alerts about a genetic testing program enticing agents with a generous commission for each client who provides a swab for the cancer screening. The agents are told that the program is legal because the test has been approved by the Centers for Medicare & Medicaid Services (CMS). Jameson Keller, vice president of strategic development for AgencyRM, says the program is a potential scam to get agents to “pay to play and to gain beneficiary Medicare information.”

Keller, a member of RISE’s Medicare Market Advisory Board, says these cancer genome testing programs violate the federal Anti-Kickback Statute (42 USC § 1320a-7b) and are potential fraud, waste, and abuse violations.

“Regardless of whether or not the test is CMS approved, we believe that the payment to agents to get clients to take the test violates the Anti-Kickback Statutes,” he says in the warning, noting that the statute applies to everyone, not just physicians.

Insurers and senior Medicare patrols are also notifying members about similar DNA and genetic test scams, which they report is occurring in multiple states at local health fairs, broker offices, convenience stores, grocery stores, and shopping malls. As part of the scheme, individuals tell Medicare beneficiaries that the genetic testing is part of a free health screening and they need only provide a cheek swab, their ID and Medicare information, to receive their test results. 

Medicare only pays for DNA or genetic testing in rare circumstances when it is deemed medically necessary for treatment or diagnosis of a medical condition. The tests must be ordered by the patient’s own physician and medical record documentation must validate the need for the tests.

Click here to view the full AgencyRM alert.