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Genetic testing fraud is a growing problem

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Better Business Bureau shares examples of the millions of dollars illegally collected by genetic testing fraudsters and offers consumer tips.

Randy Hutchinson
| Guest columnist

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  • Randy Hutchinson is president and CEO of the Better Business Bureau of the Mid-South.

The headline of an article I read stated that genetic testing fraud could be the next big concern for the American healthcare system.

Considering that a lab owner was sentenced to 27 years in prison last year for defrauding Medicare of $187 million for genetic testing, it’s scary to think the numbers could get any worse.

Minal Patel of Atlanta owned LabSolutions, which was enrolled with Medicare to perform advanced genetic testing.

The Justice Department says he conspired with patient brokers, telemedicine companies and call centers to contact Medicare beneficiaries and falsely claim that Medicare would cover expensive genetic testing for cancer.

If the Medicare beneficiary agreed to the test, Patel paid kickbacks and bribes to the brokers to find a telemedicine doctor who would authorize the test. Doctors approved the tests even though they did not treat Medicare beneficiaries, often never spoke to them and did not evaluate the medical necessity of the tests.

Over a three-year period, Patel submitted $463 million in claims to Medicare; it paid $187 million. He personally received $21 million.

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Federal officials begin looking for deception

Three people were arrested in Texas for carrying out a similar scheme through a company called ApolloMDx.

They offered illegal kickbacks to buy recipient information from marketers and orders for genetic tests from doctors.

Some doctors falsified diagnoses to make it appear that patients were eligible for genetic testing when this was not the case. ApolloMDx also changed the service dates on test orders to appear as if multiple DNA samples were collected on different dates to bill for additional services.

These crooks billed Medicare for $142 million in genetic tests. When they were arrested, Texas authorities and the FBI seized sports cars, a sailboat and property worth a combined $7.1 million.

The FBI Special Agent in Charge of the Patel case said: “Deception, kickbacks and kickbacks have no place in providing legitimate genetic testing and telemedicine services to patients who need them. Our message to those committing Medicare fraud and stealing from American taxpayers is clear: you will be caught and held accountable.”

Five tips to protect yourself against fraud

The Inspector General for the U.S. Department of Health and Human Services says fraudsters are also targeting Medicare beneficiaries through booths at public events, health fairs and door-to-door visits. Victims’ information can also be used to commit identity theft. The Inspector General warns that if Medicare denies a genetic testing claim, the Medicare beneficiary could be responsible for the entire cost of the test, which could be thousands of dollars.

The Inspector General offers this advice to protect yourself:

  • If a genetic testing kit is sent to you, do not accept it unless it has been ordered by your doctor. Refuse delivery or return it to sender. Please note the sender’s name and the date you returned the items.
  • Be suspicious of anyone who offers you “free” genetic testing and then asks for your Medicare number. Your personal information may be used in other fraud schemes.
  • A doctor you know and trust should assess your condition and approve any requests for genetic testing.
  • Medicare beneficiaries should be cautious about unsolicited requests for their Medicare numbers. If anyone other than your doctor’s office asks for your Medicare information, do not provide it.
  • If you suspect Medicare fraud, please contact the HHS OIG Hotline.

Randy Hutchinson is president and CEO of the Better Business Bureau of the Mid-South.

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