Fraud Alert Genetic Testing or Cancer Screening June 2019
June 2019

FRAUD ALERT: Genetic Testing / Cancer Screening

The Centers for Medicare & Medicaid Services (CMS) has received inquiries and complaints from Medicare beneficiaries who have been billed for Genetic Testing or Cancer Screenings performed at community events and senior centers. Representatives of genetic testing companies, including insurance agents representing these companies, attend health care events at senior centers and housing complexes offering to perform screenings and tests.

The Senior Medicare Patrols (SMPs) want to remind you of the following:
• Do not give out your Medicare number or Social Security number. Be cautious of unsolicited requests for your Medicare or Social Security numbers. If your personal information is compromised, it may be used in other fraud schemes.
• Do not consent to any lab tests at senior centers, health fairs, or in your home. Be wary of claims that genetic tests and cancer screenings will be at no cost to you.
• All diagnostic x-rays tests, diagnostic laboratory tests, and other diagnostic tests must be ordered by the physician who is treating the beneficiary, that is, the physician who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary’s specific medical problem. Tests not ordered by the physician who is treating the beneficiary are not reasonable and necessary.
• Genetic tests and cancer screenings must be medically necessary and ordered by your doctor to be covered by Medicare. Random genetic testing and cancer screenings are not covered by Medicare. If you are interested in such a test, consult with your doctor.

Monitor your Medicare Summary Notices and Explanations of Benefits for services billed that you didn’t have or that were offered and you declined. Medicare Summary Notices are sent every three months when you receive services or medical supplies during that 3-month period.

Call 1-800-MEDICARE, 800-HHS-TIPS or the Senior Medicare Patrol (SMP), 800-432-4040 if you think you’re a victim of fraud. In Pima County, your local SMP is Pima Council on Aging (PCOA). Call PCOA at 520-790-7262 to report suspected Medicare fraud, errors, and abuse.