Action 9 investigated how "free" genetic tests to uncover potential diseases turn into $30,000 medical bills and taxpayers are picking up the tab.
Consumer Investigator Todd Ulrich exposed how companies approach consumers at health fairs to collect personal information for controversial and in some cases fraudulent billing.
At a local senior health fair, Russ Loyd came across offers to unlock medical mysteries about diseases he could face.
“It wouldn't cost us anything. A simple test. Swab your cheek and off you go,” Lloyd said he was told.
At the health fair, Lloyd said a company called Advatest from Palm Harbor claimed its genetic testing could be a lifesaver.
“If we were predisposed to pancreatic cancer or something like that, it would tell us,” Lloyd said.
He filled out Medicare and doctor information. Lloyd expected his plan would be billed a few hundred dollars. Then he got his Medicare statement. The total cost was $29,000 and the government approved and paid nearly $10,000.
“It's mind boggling,” Lloyd said.
“Could you believe it?” Ulrich asked.
“No, I could not. That's just ridiculous,” Lloyd said.
It didn't cost him anything but as a taxpayer, he felt taken.
“I believe in reasonable costs for reasonable things,” Lloyd said.
Last year, the Centers for Medicare and Medicaid Services approved paying for genetic testing but only under certain circumstances. Testing is covered if it’s medically necessary and ordered by a treating doctor.
Lloyd said Advatest never mentioned anything like that.
“Would you have done that test?” Ulrich asked.
“No, absolutely not,” Lloyd replied.
“That testing is supposed to be ordered by a physician that has a connection. That has a physician patient relationship,” said Louis Saccoccio, CEO of the National Health Care Anti-Fraud Association.
Critics like the National Health Care Anti-Fraud Association warn genetic testing is a prime target for taxpayer waste, even fraud, and many testing clinics are cashing in.
“And if they're asking for your insurance or medical information in that setting, it’s something to be really cautious about,” Saccoccio said.
The Department of Health and Human Services Inspector General issued a fraud alert that included a warning about genetic tests offered at health fairs.
Ulrich contacted Advatest managers a week ago. The company has not responded.
“This is just totally ridiculous,” Lloyd said.
Lloyd sent a complaint to Medicare investigators.
The fraud alert warns these tests are also offered through telemarketing calls and door-to-door sales.
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