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Scam Alert: Genetic Testing

SCAM ALERT:  Genetic Testing

 

In this scam, fraudsters take cheek swabs from anyone (prime target are full dual Medicare Medicaid eligible), collect their personal information, and their insurance billing info, including Medicare numbers.   The cheek swabs can then be sent on to a lab to be tested.  The lab or the fraudsters will then bill Medicare for the test.  They do need to have a doctor sign off on them, so they will sometimes try and get the fraud victim’s doctor to sign off on them.  If they can’t get the victim’s doctor to sign off, they will “hire” a doctor typically providing them a financial kickback for each test they sign off for.  The beneficiary may or may not receive any actual results from the test.

 

Here are the problems with the scam.  These tests can cost Medicare over $10,000 per test.  If Medicare only pays the 80%, the beneficiary could receive a bill for the 20% copay.  If they have a secondary insurance, that insurance will then pay that copay.  If the person has Medicaid, Medicaid would pay the copay.  Outside of huge costs to Medicare, other insurances, and taxpayers in general, individuals can then have their Medicare numbers sold to other fraud groups, resulting in further fraudulent changes billed to their Medicare number.

 

What can be done?  If people think they might have given their Medicare numbers out to this group or any other fraudulent group, they should call 1-800-Medicare (1-800-633-4227) to report the fraud.  When making the call, they should try and provide Medicare with as many detail they can of the incident, the name of the group, and phone numbers or contact info for the fraud group.  People can also report suspected fraud to the Office of the Inspector General for Health and Human Services.  This is the fraud investigative unit for Medicare.  Their phone number is 1-800-447-8477.  They can also contact a MMAP counselor, who can help assist them in reporting these instance too.  Lastly, if people suspect they’ve been taken advantage of by a fraud, they should review all of the Medicare Summary Notices to identify if there have been any irregular billing made to their Medicare number.  If they suspect fraudulent billing, they can contact MMAP or 1-800-Medicare.  

 

While we have seen these groups change their names, there could be as many as three different groups who have been active in Newaygo, Mason, and Wexford counties.  Momentum Community Care/Direct Medical Testing, Advantage Medical Testing, and Positive Genomics are the names of the three possible groups.  If anyone has interacted with any of these groups, they can report this to OIG, 1-800- Medicare or to the main MMAP line. 

 

Attached are two new resources that MMAP received from the National Senior Medicare Patrol Resource Center.  SMP is a national volunteer program to educate and report Medicare and Medicaid fraud and abuse.  Feel free to share these materials.