Beware of Genetic Testing for Beneficiaries in Group Settings

Virginia SMP is getting reports from neighboring states of people giving presentations to seniors or offering ice cream socials while also conducting a free “check swab” for genetic testing. Individuals promoting genetic testing of Medicare beneficiaries through meetings and educational sessions could be using this test to commit Medicare fraud and abuse. These genetic tests are intended to help alert people about potentially negative interactions to medications they are taking and help the individual determine if they will respond well to certain drug therapies. Medicare only covers such a test if there are already signs, symptoms, complaints, or a personal history of disease or injury justifying a test, and if a physician orders it. Please note that Medicare does NOT cover it as part of a generic group screening.

If you encounter people offering such group screenings, saying Medicare covers this test free of charge and that all you need is your Medicare number, stop. This is a red flag. Do not give them your Medicare number. They may be committing fraud or abuse and charging Medicare over $1,100 for unneeded tests.

Recently, American international Biotechnology (AIB) a Virginia-based medical research company was required to pay $343,000 to Medicare to settle healthcare fraud claims in Greene County, Pennsylvania. The Justice Department said that one of its former contract sales agents ripped off the government by fraudulently marketing genetic tests to patients at a medical office and violating the federal False Claims Act by obtaining improper referrals for genetic tests and billing them to Medicare. The scam was uncovered when patients at Lions Medical Center in Rices Landing, PA began receiving statements from their insurers indicating that AIB was seeking reimbursement for cheek swab tests the patients had been told were free.

What you can do:

  1. Do not give your personal information to these individuals or companies.
  2. If you or someone you know comes across this scam, decline their services and let us know. Call Virginia SMP at 1-800-938-8885.
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