Compliance: Cancer Genome Testing
Updated March 11, 2019
Bottom line
We believe these programs violate the Federal Anti-Kickback Statute(42 USC 1320a-7b)and is potentially a Fraud, Waste, and Abuse violation. We strongly encourage you to avoid participating in these Cancer Genome Testing programs.
Details
Multiple entities and labs have begun recruiting agents to offer a genetic cancer screening swab to their clients and prospects. Offers of $400-$900 per swab in “commission” are being made to agents.
Agents are being told this is a completely legal program as the test is CMS approved. Regardless of whether or not the test is a CMS approve, we believe that the payment to agents to get clients to take the test violates the Anti-Kickback Statutes.
The Anti-Kickback Statute applies to everyone, not just physicians: Whoever knowingly and willfully solicits or receives any remuneration [] in return for [] arranging for [] or ordering [any service] for which payment may be made in whole or in part under [Medicare]shall be guilty of a felony.(edited to cut out extraneous language)
We have reported these programs to multiple carriers who have confirmed they believe this is a legal and compliance violation. They are working to notify CMS who will take the appropriate action. We have also heard from two separate attorneys confirming our belief this is a legal violation.
When investigations conclude and we hear back from carriers and/or CMS, we will update you with the information.
UPDATE: Multiple insurance carriers have come out and stated that genetic testing like this is NOT a CMS covered benefit and that this is a scam to get agents to pay to play AND to gain beneficiary Medicare information.
