Consumers are being targeted by a new scheme resulting in phony claims to the U.S. government sponsored healthcare programs and private insurance companies.
The scheme includes medical providers, marketing companies, call centers, and laboratories working together or separately to conduct genetic testing for people without a medical need. The testing typically doesn’t take place; however, bills are still submitted to government or private health insurance agencies. Patient records are falsified to conduct these unnecessary tests, and physicians write prescriptions for unnecessary equipment or medical supplies which is not needed or provided to the patient. This scheme may include collaboration with providers to obtain patient referrals, higher insurance reimbursement rates, cash or other benefits.
Senior citizens are targeted more often as they seek medical attention on a more frequent basis and typically receive Medicare benefits. Healthcare fraud actors will attend events including health fairs, community centers, low income senior housing, and senior events to identify potential victims. They will offer “free” genetic tests and request personal identifiable information from participants. In addition these representatives with convince seniors they are more susceptible to health problems without these genetic tests. Fraud actors also attempt to gather this information by calling seniors, visiting their homes, and through television and social media.
Below is a list of potential indicators provided by the Office of Private Sector. Though this alone cannot accurately determine fraudulent activity, the totality of the circumstances should be taken into consideration
- Advertising for genetic testing including:
- Telephone solicitation
- Door-to-door visits
- Social media/Internet ads
- Television commercials
- Genetic testing offered as “free” or at “no cost”
- Items, including gift cards, in exchange for submitting to genetic testing
- Genetic testing being scheduled but never completed, or never receiving results of testing
- Genetic testing being offered at events
- Genetic testing being offered by non-healthcare affiliated organizations
- Use of fear-based advertising
Please contact us or local law enforcement if you are concerned that you may have fallen victim to this type of fraud so that we can assist you with protecting your accounts and identity.