Here's what you should know about an alleged $2.1 billion scam
by Mark Taylor, AARP,
September 30, 2019
After a sweeping crackdown on bad actors
blamed for $2.1 billion in Medicare fraud, federal officials are urging older
Americans to refuse offers of “free” genetic testing for cancer.
Equally important, they urged people to
safeguard their Medicare identification numbers so they do not fall into the
hands of fraudsters.
Federal officials announced on Friday charges
against 35 people after a nationwide probe centered on false billings for medically
unnecessary genetic tests for cancer.
They said the cases constitute one of the
largest frauds in the history of Medicare, which was implemented in 1966 to
provide health coverage to Americans age 65 and older.
The crackdown was called Operation Double
Helix, named for the description of the structure of a DNA molecule.
The probe, which began last year, ensnared
telemarketing firms, patient recruiters, physicians and medical testing
laboratories that preyed on seniors. Nine physicians associated with dozens of
genetic testing laboratories were among those charged. The defendants live in
Florida, Georgia, Louisiana, Texas and South Carolina.
The probe was conducted by the federal
prosecutors working with the FBI and the law enforcement arm of the Health and
Human Services Department, its Office of Inspector General.
Officials said the case heightens the need for
seniors to protect themselves from Medicare billing
scams and noted that the genetic testing scam is ongoing.
The fraud occurs when Medicare is billed for a
test or screening that is not medically necessary or not ordered by a
beneficiary's treating physician.
The first step to avoid getting scammed is
to guard your
Medicare number, officials said. Share it only with trusted health
care providers you know. Don't give it out to a stranger whether in person, on
the phone or online — however credible they might sound. Once compromised, a
Medicare number can be used in other fraud schemes, costing the program
valuable dollars and potentially making beneficiaries personally liable for
payments.
Officials advise seniors to refuse delivery of
genetic or DNA tests or to return them to the senders unless their personal
physicians ordered them. Keep records of the sender's name and the date you
returned the test.
If you have a medical concern, be sure your
doctor examines you and assesses your condition. While Medicare does cover many
genetic tests for diagnostic purposes, it only covers one to screen for cancer.
Officials also urge beneficiaries to regularly
examine their Medicare Summary Notice (MSN), which details an explanation of
benefits (EOB) and bills from providers. Beneficiaries should look for key
words like “gene analysis,” “molecular pathology” or “laboratory.”
Report Suspicious Medicare Bills
If a service, test or bill appears suspicious
or arrives from a provider they don't recognize, seniors should contact their
local Senior Medicare
Patrol (SMP) or contact the HHS OIG.
To find your
state's Senior Medicare Patrol National Resource Center,
call 877-808-2468.
To contact the HHS OIG hotline, call
800-447-8477.
Here's how the scheme typically unfolded:
Recruiters, often at county fairs and other public events, targeted
Medicare beneficiaries for genetic tests either in person (by
swabbing their cheeks for DNA) or by mail (shipping them at-home DNA kits), and
obtained Medicare numbers.
The recruiters, who sometimes went
door-to-door hawking the genetic tests, exploited seniors’ fears of having
genes that might put them at higher risk of getting cancer. Then recruiters
passed on the patient information to the doctors, who allegedly ordered the
tests for beneficiaries they never met or examined.
Officials said the physicians were paid
kickbacks for the tests they ordered. Labs ran the tests, billed Medicare and
paid the patient recruiters. Often the beneficiaries never received the results
of the tests, which were worthless to beneficiaries’ own doctors.
Many beneficiaries also were billed for the
tests, which they were told would be free.
Officials said two defendants from Georgia and
their labs billed Medicare more than $1 billion: Minal Patel, 40, of Atlanta,
and Khalid Satary, 47, of outlying Suwanee, Georgia.
At the Justice Department, Assistant Attorney
General Brian Benczkowski said the defendants in the case “allegedly duped
Medicare beneficiaries into signing up for unnecessary genetic tests, costing
Medicare billions of dollars."
In Miami, U.S. Attorney Ariana Fajardo Orshan
also decried their behavior, saying: “The genetic-testing fraud schemes put
personal greed above the preservation of the American health care system.”
The crackdown comes in an era when genetic
testing has become commonplace through legitimate firms like 23 and Me and
Ancestry.com, which trace family histories and analyze DNA. Officials said the
scammers “exploit the promise of new medical technologies such as genetic
testing and telemedicine for financial gain, not patient care."
A decade ago, it would have given Medicare
beneficiaries pause if someone wanted to swab their cheek to obtain a saliva
sample, Shimon Richmond,
with the HHS Office of Inspector General, told the Associated Press.
"Today people know and recognize what
(genetic testing) is, and they think ‘I can get that done, and I can get it
done for free and find out if I have health issues that I need to address,'” he
said.
AARP’s Fraud Watch Network can help you spot
and avoid scams. Sign up for free “watchdog alerts,"
review our scam-tracking
map, or call our toll-free fraud helpline at
877-908-3360 if you or a loved one suspect you’ve been a victim.
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