OIG Alert: Beware of Genetic Testing Scam

A blue door with two small holes in it.

The U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) recently sent out an alert about a fraud scheme involving genetic testing.

The government watchdog agency said Medicare beneficiaries are being offered the chance to get tested for certain genetic conditions through the use of a simple cheek swab, but they must provide those offering the tests with their Medicare information.

Beneficiaries are being targeted via telemarketers, during health fairs and even door-to-door. HHS is urging those being contacted not to provide the information to anyone, other than a trusted physician, as the information not only might be used in this scheme, but in other possible fraudulent schemes.

Any test must be ordered by a physician be and medically necessary in order to be covered by Medicare and other payors. In past instances, (see below) physicians and other healthcare providers have been recruited and paid to sign off on such tests.

Genetic testing is just the latest area that is ripe for fraud and abuse. As we wrote about here, and here, several genetic testing labs have found themselves under investigation for paying kickbacks to physicians for ordering unnecessary genetic tests and then billing federal healthcare programs including Medicare.

The OIG has stated that Medicare will not pay for preventive screening tests, except those specifically authorized by statute. Since the Centers for Medicare & Medicaid (CMS) considers predictive tests to be screening tests, genetic tests for this purpose are not covered by Medicare.

Last month, a New Jersey man was sentenced to more than four years in prison and ordered to pay $435,000 in restitution, after pleading guilty to one count of conspiracy to commit healthcare fraud. It was alleged that Seth Rehfuss and others used a nonprofit to get older adults to submit to genetic tests that he said would help them guard against heart attacks, cancer and other diseases.

“To get the tests authorized, Rehfuss used advertisements on Craigslist to recruit healthcare providers (physicians, nurses and physician assistants) for the scheme. The healthcare providers were paid thousands of dollars per month to sign their names to requisition forms authorizing testing for patients they never examined or had any interaction with,†according to a news release.

One of his co-conspirators previously was sentenced to 13 months in prison and ordered to pay restitution of $1.2 million, while another was sentenced to 19 months and ordered to pay 525,000 and forfeit another $525,000.

Several of the practitioners who were recruited were listed as co-conspirators.

Healthcare providers should be advised that accepting remuneration in return for ordering unnecessary tests is a violation of the Anti-kickback law and can land them in jail, subject them to fines and even result in the loss of their license.

The Health Law Offices of Anthony C. Vitale can provide you with compliance oversight services, assuring that your business relationships are compliant with all federal and state fraud, waste and abuse laws. We also represent healthcare professionals in state and federal court who are charged with fraudulent billing, kickbacks, Medicare and Medicaid fraud and false claims, among others.

Our team of highly skilled attorneys and consultants can assist before you become the focus of an investigation and will aggressively defend you should you become the target of one.

Give us a call at 305-358-4500, or send an email to info@vitalehealthlaw.com and let’s discuss how we might be able to assist you.

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