The headline of an article I read said that genetic testing fraud could be the next big concern for U.S. healthcare. Considering that one lab owner was sentenced last year to 27 years in prison for defrauding Medicare out of $187 million for genetic tests, it’s scary to think the numbers could get worse.

Minal Patel of Atlanta owned LabSolutions, which was enrolled with Medicare to perform sophisticated genetic tests. The Department of Justice says he conspired with patient brokers, telemedicine companies, and call centers to contact Medicare beneficiaries and falsely claim that Medicare would cover expensive cancer genetic tests. 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 weren’t treating the Medicare beneficiaries, often never spoke to them, and made no evaluation of the medical necessity for the tests.

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

Three people were arrested in Texas for operating a similar scheme through a company called ApolloMDx. They offered illegal kickbacks to purchase recipient information from marketers and orders for genetic testing from doctors. Some doctors falsified diagnoses to make it appear patients were eligible for genetic testing when they weren’t. ApolloMDx also altered dates of service on testing orders to make it appear multiple DNA samples were collected on different dates in order 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 properties worth a combined $7.1 million.

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

The Inspector General of the U.S. Department of Health and Human Services says fraudsters also target Medicare beneficiaries through booths at public events, health fairs and door-to-door visits. Victims’ information may 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 mailed to you, don’t accept it unless it was ordered by your physician. Refuse the delivery or return it to the sender. Keep a record of the sender’s name and the date you returned the items.
• Be suspicious of anyone who offers you “free” genetic testing and then requests your Medicare number. Your personal information may be used in other fraud schemes.
• A physician you know and trust should assess your condition and approve any requests for genetic testing.
• Medicare beneficiaries should be cautious of unsolicited requests for their Medicare numbers. If anyone other than your physician’s office requests your Medicare information, do not provide it.
• If you suspect Medicare fraud, contact the HHS OIG Hotline.