Genetic testing is promising, but beware fraud
August 1, 2019
Genetic testing has certainly become a phenomenon in the last few years. This amazing new type of medical test, also known as DNA testing, has diverse applications. It can determine bloodlines of familial relationships, can rule out or confirm certain genetic conditions, or determine the likelihood of passing on genetic disorders. There are some conditions or diseases caused by mutated genes that genetic testing can confirm, such as Down Syndrome, Cystic Fibrosis, or Huntington’s Disease. DNA tests can verify the ability of a person to metabolize certain medications, which helps determine how well a person will respond to medicinal therapies.
The material used for genetic testing can come from a variety of sources. Samples of blood, skin, hair, a swab from the inside of your cheek, or even amniotic fluid can be used to provide a sample. Typically results are available rather quickly, within two to four weeks at commercial labs. Often genetic testing is combined with other pertinent pieces of information about you such as your medical history and your family history of disease, patterns to assist in confirming test results.
Unfortunately, with the advent of this very helpful tool, genetic testing scams have become pervasive across the country. Medicare beneficiaries are being targeted, approached and offered “free” testing.
Companies who are perpetrating Medicare fraud will offer you “free” genetic testing without a physician’s order or diagnosis and then bill Medicare. They may often claim that Medicare will cover the tests at little or no cost to you. They may use several different approaches. You may see them at a local community event, such as a health fair, farmer’s market, or other get-together. They may offer you a “free” test that you did not request or do not need. Asking for your Medicare information, they tell you that Medicare will cover it. Some of the conditions that they promise they can test for are: cancer, heredity cancer, dementia, Parkinson’s disease.
Remember, in order for Medicare to cover any tests, you must have an order for the test from your provider. Medicare does not cover genetic tests for people who are not experiencing any symptoms. Genetic testing is not covered under the preventive services that Medicare will cover at 100%. Be careful. If Medicare denies coverage for the genetic testing, you could be responsible to pay for the costs, which can run anywhere from $285 to $3,920, depending on the test. Multiple tests can be run from each cheek swab sample.
How can you protect yourself? Be sure your provider has assessed your symptoms and has determined that your condition merits genetic testing. There are many genetic tests that Medicare does not cover. Do not give out your personal information or accept screenings offered at community events. Check your Medicare Summary Notice for any claims that were denied or for tests that your provider did not order. Especially look for terms like “gene analysis” or “molecular pathology”.
Genetic testing is a new and wonderful tool in our medical diagnostic toolbox, but in order to protect yourself from unnecessary costs, you must be wise because bad actors do not have your best interests at heart and are more than happy to take advantage of you for their profit no matter what it may cost you in compromising your identity or unexpected costs.
If you have been approached and/or have provided a cheek swab or other genetic material for testing and now feel it was not medically necessary, contact the Medicare Information Office in Alaska at 1-800-478-6065, or 1-800-Medicare, and notify them about possible fraud.
Nila Morgan is a Certified Medicare Counselor who works at the Anchorage Senior Activity Center.