Texas SMP

Medicare patients should be on the lookout for a new phone scam.

Callers are offering Medicare beneficiaries genetic testing cheek swabs to obtain their Medicare information for fraudulent billing purposes or possibly medical identity theft.

“We're hearing reports of scammers calling Medicare beneficiaries, claiming their cardiologist wants them to have this test and offering to send a kit. In reality, their cardiologist did not make any such request,” said Jennifer Salazar, Program Director with the Texas Senior Medicare Patrol. “Their goal is not to help the beneficiary; it’s to get their Medicare information, which scammers can use to bill Medicare for medically unnecessary genetic testing.”

If Medicare denies a cardiovascular genetic test claim, a beneficiary might be responsible for the entire cost of the test – $9,000 to $11,000. Cardiovascular genetic testing is covered by Medicare when the test is medically reasonable and necessary, and when a treating physician orders the test. Avoid this scam by taking the following steps:

• Be sure your doctor has assessed your condition. Medicare covers many genetic tests to detect heart disease, but these tests do not predict or screen for cardiovascular disease;

• Do not give out personal information to anyone who calls and claims that a cardiologist has requested cardiovascular testing;

• Do not give out your personal information or accept screening services from anyone at a community event, local fair, farmers’ market, parking lot or any other public event;

• Always read your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB). The words “gene analysis,” “molecular pathology,” or “laboratory” may indicate questionable genetic testing has occurred;

• If you received a cardiovascular genetic testing kit or test that was not medically necessary, report your concerns about billing errors or possible fraud and abuse to the SMP hotline (see below).

The Senior Medicare Patrol (SMP) investigates potential fraud and abuse issues. Call the Texas Senior Medicare Patrol hotline at 888-341-6187 for more information.

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