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Medicare beneficiaries targeted in scheme involving cardiac DNA test; FBI warns public about fraud

Criminals submit medical tests to bill Medicare and pocket the money, the FBI says
Posted: 5:28 AM, Mar 02, 2022
Updated: 2022-03-02 07:56:07-05
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MILWAUKEE — Federal authorities are warning consumers, especially Medicare beneficiaries, about a scheme involving genetic testing.

Consumer investigator Kristin Byrne interviewed a Milwaukee County couple, Teegee and Alan Levy, who explained what happened to them in hopes no one else falls for this kind of fraud.

The couple said it started with a package being delivered to their doorstep via UPS. Within minutes after the package was dropped off, Teegee got a call from an unknown number.

"He was from the lab and he sounded very professional and very personable," said Teegee.

"He had our telephone number and the name of our primary care doctor, and he said that the doctor had ordered this test for cardiac," she said.

Inside the box was a test tube and also directions for Teegee to do a cheek swab for a cardiac DNA test.

"The package had a UPS label on it and there were instructions in it on how to take a DNA test," said Teegee.

"I've had cardiac issues and so saying they were going to test for cardiac issues seemed to make sense," said Alan.

"And my father died when I was 12 from heart disease," said Teegee.

Alan ended up following the same process. Again, a package arrived with the testing material and a man from the lab walked him through it.

"He engaged me in a conversation after we had done the swab, he wanted us to go put it outside so that UPS could pick it up," Alan said.

"So, it seemed normal," said Teegee.

"It seemed like it was part of that process," Alan said.

The couple has a new doctor and thought this was nothing out of the ordinary. They were told the results of the test would be ready in about five weeks.

"So, now it's about 5 weeks later and we call the doctor to say, 'did you get the results?' and the doctor responds with, 'I don't know what you're talking about. I didn't order anything like that,'" Alan said.

"And that's when we knew it was a scam," Teegee said.

Supervisory special agent with the FBI Christopher Farrell says what happened to the Levy's is all too familiar.

"Across the country, and even in Wisconsin, we have investigations here at the FBI that is looking into schemes just like this," said Farrell.

"Anytime anyone calls you, basically a cold call about any type of test that you should take, DNA test, genetic test, even if they have your doctor's name by chance, it is most likely a fraud," said Farrell. "You should be receiving your test directly from your doctor at an in-patient visit."

He says criminals submit medical tests to bill Medicare and pocket the money.

The U.S. Department of Health and Human Services has warned the public about this kind of fraud, stating, "Scammers are offering Medicare beneficiaries 'free' screenings or cheek swabs for genetic testing to obtain their Medicare information for identity theft or fraudulent billing purposes."

"In order to prevent you becoming a victim of any type of health care fraud, is to protect your health insurance information - the same as you would your social security number," Farrell said.

The Levy's told TMJ4 they didn't give out any personal information but did fill out some basic paperwork that came with the test. They said the caller already knew their Medicare beneficiary numbers.

The couple believes in their case, they were being used for others to commit fraudulent billing.

"In all of that there's a kickback scheme usually where the lab that's doing the test, when they get the money, they're giving money back to either the marketer, that's calling the people to get these tests, or sometimes even the doctor," he explained.

To be clear, it's not your doctor that's involved. It's someone else taking part in the fraud.

According to Farrell, the DNA isn't what the con-artists are after.

"The test is a real test and it's going to a real lab," he said.

"It's a complicated and complex scheme that involved multiple people and even companies that come together to engage in this type of health care fraud," he added.

The U.S. Department of Health and Human Services says if Medicare denies the claim, there's a chance you would be stuck paying the cost of the test, which could be thousands of dollars.

"This isn't fun and games. This is financial gains," said Teegee.

The couple hasn't seen a bill for the test. They contacted UPS, Medicare, several federal agencies, and local police to report what happened.

They were told to monitor their Medicare claims.

"So, if we see something that gets denied and it's a lab, we're going to know. Or whatever it is, we're going to raise the question immediately," said Alan.

That's exactly what Farrell recommends. He says anyone who suspects health care fraud should closely monitor their "Explanation of Benefits" paperwork that you receive in the mail. That way, you can closely examine what medical charges are being billed to your insurance.

"I thought that I was smart. Evidently not," Teegee said.

Since the Levy's didn't think this was anything out of the ordinary, they didn't take photos of the package or testing materials or write down the sender's name or number that called them. So, investigating their case could be hard without that evidence. For them, the most important part of telling their story is warning other seniors that this scheme is out there.

If you believe you are a victim of a scheme similar to this health care fraud, you can contact the FBI at 1-800-CALL-FBI.

Another option is to contact the Office of the Inspector General within the U.S. Department of Health and Human Services at TIPS.HHS.GOV or 1-800-447-8477.

Medicare beneficiaries can reach out to Medicare at 1-800-MEDICARE.

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