ALERT: Potential Genetic Testing Scam
Recently, the Centers for Medicare and Medicaid Services (CMS) alerted Aetna of a scam designed to generate Medicare member referrals to genetic testing companies. Please read this communication so you know what to watch out for and can help educate your clients.
|Agents: Please be wary of any offers of payment in exchange for referrals of Medicare members for genetic testing or other medical services covered by Medicare. This may be part of a scam.|
About the scam
The scam is occurring in multiple states at a variety of locations, including places like local health fairs, broker offices, convenience stores, grocery stores and shopping malls.
Based on the limited information known at this time, it appears that some individuals are offering Medicare beneficiaries a cheek swab for genetic testing as part of a free health screening. Beneficiaries are told they just need to provide a cheek swab, and their ID and Medicare information, to receive their test results.
Medicare does not pay for these types of genetic predisposition (screening) tests. Additionally, requesting Medicare member information and/or providing it to a lab unnecessarily may potentially result in fraudulent activity.
Agent recruitment tactics
It’s been reported that some entities are recruiting agents and agencies to participate in getting their clients signed up for genetic testing. Agents are given the impression that the program is approved by Medicare and by carriers, which is not true. They charge agents upfront to participate and then pay agents for each client referred for genetic testing.
What you need to know – Your responsibilities as an agent
As an agent representing Aetna and Aetna Coventry Medicare plans, you must follow Aetna and CMS requirements. You’re responsible for knowing the rules and complying with them.
Aetna absolutely does not condone or approve of any activities that violate CMS regulations. Any agents found conducting activities that are prohibited by CMS would face corrective action up to termination of their contract (“for cause”).
Remember, you play an important role in preventing fraud and abuse
As one of Aetna’s contracted agents, you’re required to report all suspected or actual occurrences of non-compliance, fraud, waste or abuse. There are four ways to report potential issues. You can:
- Make an anonymous call to the AlertLine (1-888-891-8910)
- Visit AlertLine on the web, at Aetna.alertline.com
- Write to Compliance, P.O. Box 370205, West Hartford, CT 06137-0205
- Email Medicare Compliance at Medicarecompliance@aetna.com or MedicareFDR@aetna.com
Resources to help you stay compliant
- Aetna Medicare Marketing Code of Conduct
- CVS Health Code of Conduct
- Aetna Medicare Producer Guide
- CMS Medicare Communications and Marketing Guidelines
- Aetna Medicare Compliance 101 training
- Medicare Marketing Do’s and Don’ts
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