November 11, 2019

November 11, 2019

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November 08, 2019

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OIG Issues Fraud Alert Regarding Fraudulent Genetic Testing Schemes

Earlier this week the OIG took the somewhat unusual step of issuing a fraud alert directed to Medicare beneficiaries (rather than to Medicare providers) regarding “fraud schemes” that involve genetic testing.  According to the OIG, beneficiaries are being offered genetic tests in order to obtain their Medicare information, which is then used to commit identity theft or to submit fraudulent claims to Medicare.  Beneficiaries are being targeted through telemarketing calls, booths at public events, health fairs, and door-to-door visits.

The OIG provides the following takeaways to Medicare beneficiaries:

  • Offers of free genetic tests coupled with requests for a beneficiary’s Medicare information should be viewed as suspect.

  • Genetic tests should be approved and requested by a beneficiary’s known physician.

  • Medicare information should only be provided pursuant to a request from the office of a beneficiary’s physician. Unsolicited requests for Medicare information should be viewed with caution.

A primary concern of OIG is the fact that the beneficiary receives a testing kit even if the testing is not medically necessary and is not ordered by a physician.  While Medicare generally does not cover genetic testing conducted for screening purposes, it does reimburse for certain genetic testing conducted for diagnostic purposes, as long as it is medically necessary and is ordered by a physician as required by Medicare regulations.  Further, this type of scheme should not be confused with legitimate telehealth arrangements that involve the ordering of medically necessary laboratory testing. 

This latest alert comes on the heels of another fraud alert directed to consumers in April 2019 regarding a scheme involving orthotic braces, which was coupled with an announcement of federal criminal enforcement action in this area.  We are monitoring these enforcement issues and will follow up with reports of any similar enforcement action involving laboratory testing.

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About this Author

Karen Lovitch Mintz DC Health Care Compliance, Fraud & Abuse, and Regulatory Counseling Medicare, Medicaid & Commercial Coverage & Reimbursement Health Care Transactions Health Care Transactional Due Diligence Health Care Enforcement & Investigations
Member

Karen focuses her practice on representing health care companies in regulatory, transactional, and operational matters. She has a substantial health care regulatory background and advises clients on matters pertaining to the federal anti-kickback statute, the Stark law, state statutes prohibiting kickbacks and self-referrals, the Clinical Laboratory Improvement Amendments of 1988, and the federal Physician Payments Sunshine Act. Karen often applies her strategic insight on these matters to counsel companies on regulatory issues arising in connection with mergers and acquisitions and other...

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Matt advises health care clients on regulatory and transactional matters, including fraud and abuse, HIPAA privacy and security, and general contracting.

Prior to joining Mintz, Matt worked as in-house counsel at an independent hospital and outpatient facility, where he provided guidance on a range of fraud and abuse issues, including compliance with the Stark Law, the Anti-Kickback Statute, and the False Claims Act. He also counseled on HIPAA privacy and security as well as other regulatory matters. Matt handled the structuring and negotiation of physician and referral source arrangements, negotiated vendor contracts, and assisted in the formation of a Medicare Shared Savings Program Accountable Care Organization. In addition, Matt conducted due diligence and drafted, negotiated, and finalized complex transactions for the facility. He also regularly provided guidance on corporate governance issues and prepared regulatory and corporate filings.

Matt received the Health Law Certificate at the University of Maryland ‘s Francis King Carey School of Law and was a law clerk in the Office of the General Counsel at the Johns Hopkins Health System and at the Maryland Department of Health and Mental Hygiene.

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