- 6,024
When they figure out how to get paid on the < 65 client - it could be huge.
DNA cancer screening tables are a medicare scam
- Thread starter AcemanX007
- Start date
- 3,351
I know of one group that is coordinating this genetic testing nationwide and they are NOT requiring the Medicare eligible person being screened to have a referral from their primary Dr. they have an in house Dr. doing the referrals. Why is this group not shut down yet if this is illegal ?
- 6,024
Can you PM me that company name?
That Norman dude is crying wolf. Not even sure if he is an Agent. Could be related to LD.
The screens are limited to one per lifetime is my understanding.
- 2,133
I attended a national Medicare carrier OEP/DSNP training this morning and asked the reps about this. They were stunned and never heard about Medicare paying for tests for everyone. No way am I getting involved in it.
I know of one group that is coordinating this genetic testing nationwide and they are NOT requiring the Medicare eligible person being screened to have a referral from their primary Dr. they have an in house Dr. doing the referrals. Why is this group not shut down yet if this is illegal?
No idea. Maybe CMS just hasn't caught up with them yet, due to the supposed 30-day loophole?
I know of one group that is coordinating this genetic testing nationwide and they are NOT requiring the Medicare eligible person being screened to have a referral from their primary Dr. they have an in house Dr. doing the referrals. Why is this group not shut down yet if this is illegal?
No idea. Maybe CMS just hasn't caught up with them yet, due to the supposed 30-day loophole?
NormMitchell
Expert
- 43
Did you just get off the last Pineapple truck or are you just plain stupid?
Yes, Medicare has approved Genetic testing for certain cancers (several of them in fact)! In doing a Google search it appears that some of these tests were just recently approved to be paid (With Medicare Support, Genetic Cancer Testing Goes Mainstream) AND APPARENTLY Medicare may have left open a loophole which some enterprising folks have jumped on to exploit with not getting the referral from the Medicare recipients personal physician. And yes while it could currently be legal since Medicare has only 30 days to approve a Medicare bill and hasn't caught up to speed with the mass of tests which could be performed under this opportunity, it may go on for a while. But stop and think about it, these tests are expensive (Questionable tactics used to profit from genetic testing boom), should be ordered by the patients "personal doctor" and the people involved in this MLM opportunity are getting people to provide "DNA swabs" which is very personal information outside their personal doctor's office. Not everyone who has had cancer themselves or in their family benefits from DNA testing as per MD Anderson "Only about 5 to 10% of cancer cases are related to genetics," says Karen Lu, M.D., co-medical director of the Clinical Cancer Genetics Program at MD Anderson. (Who needs genetic testing for cancer?), but yes it can benefit certain people. But from CMS PAY ATTENTION!!! (https://www.regence.com/documents/1...ng+scams/3439b46a-2f97-40d2-94ec-c62e4478712e)
And who do you think is paying for these expensive genetic tests through Medicare, You & Me, the taxpayers! I don't know about you but I don't want to pay for every Tom, Dick, and Harry who gets these tests if they don't need them. Their personal doctor should be the one who is doing a referral if they feel the test is needed, not a bunch of insurance agents or as is stated in the information video anybody who wants to set up a table and get seniors to do the swabs. It may work out to be a real money-making opportunity for a while, but as a Medicare recipient I do not want to be a party to anything like this as more people who have these expensive tests done unnecessarily will increase my and your future Medicare costs. And yes both I and my wife have cancer histories somewhere in our upline family, just like most of the other population of America!
We're going to see more and more information about genetic testing as it holds a lot of new benefits for disease management, prevention and hopefully cures. But mass abuse of the Medicare system will not help those who might benefit from these important tests. Hopefully, Medicare is learning about this and will close any loopholes which exist.
And yes, I've been in the insurance business for 47 years!
- 6,024
Norman - all them links are as old as dirt . . .
Please post something current.
You posted:
But from CMS PAY ATTENTION!!! (https://www.regence.com/documents/1...ng+scams/3439b46a-2f97-40d2-94ec-c62e4478712e)
This post / flyer is not from CMS. I called the 8777723379 #'s. They didn't have a clue why peeps thought they were CMS . . .
In no official document that I can find does it dictate the test MUST be ordered by a patient's "personal" doctor . . .
You speak that Medicare has 30 days - your links are from 2015, 2016 - you'd think they'd be aware by now . . .
I think it's awesome that companies want to help people know if they have or can get cancer and it not cost them anything. Seniors have paid taxes all their lives
Please post something current.
You posted:
But from CMS PAY ATTENTION!!! (https://www.regence.com/documents/1...ng+scams/3439b46a-2f97-40d2-94ec-c62e4478712e)
This post / flyer is not from CMS. I called the 8777723379 #'s. They didn't have a clue why peeps thought they were CMS . . .
In no official document that I can find does it dictate the test MUST be ordered by a patient's "personal" doctor . . .
You speak that Medicare has 30 days - your links are from 2015, 2016 - you'd think they'd be aware by now . . .
I think it's awesome that companies want to help people know if they have or can get cancer and it not cost them anything. Seniors have paid taxes all their lives
NormMitchell
Expert
- 43
- 6,024
Don't give up just because you can factually back up your absurd claims Norm . . .
- 30,534
I guess you don't know it, but myinsurebiz has a 132 IQ.
- 6,024
I spent much of yesterday and today talking with the Principals of 3 different companies on the Screening process. It is in fact allowable under CMS rules to assist with Intakes on these tests for individuals that want to have the tests preformed.
At the moment - these Tests are being reimbursed based on which codes are being submitted based on what tests / procedures were preformed.
The test can be ordered by any Board Certified Physician. Mostly via TeleMedicine at the moment.
CMS is making the reimbursements via Medicare and also Medicade. Naturally, Medicade is paying less . . .
Private Insurance Carriers are coming onboard as well.
The difference is in whether or not a Marketing Company is compliant in their marketing, intaking, submission, etc . . .
Someone can not initiate the contact via phone, text, email, etc. The lead MUST be initiated by the Patients - via Events, Direct Mail, Commercials, etc - very similar to Part C and Part D.
It does pay very, very well depending on which Cancer Screen is used and the depth of the Patient and Family history is submitted upon intake. Crazy but a sick person with a sick family, especially death by cancer, pays more - primarily based on the coding that is submitted.
The 3 companies that I spoke with are jumping all in. Only one of them is going to do it right, in my opinion, by performing background checks on the Intake Specialists, using HIPPA certifications and seeking those in professional capacities - ie: Insurance Agents, Doctors, Nurses, etc.
Don't know how long the window of opportunity will be on this - may last may not. But - the process isn't a scam or illegal as some state. Now - the process of gathering the leads could be, depending on the methods.
2 of the 3 are using a MLM model and charging someone a fee to join as an Intake Specialist and then paying portions of that fee to the MLM sponsor. That will cause a red flag for sure . . .
The one that I am joining, is the one doing it right, doing the Background Check, etc. They only charge for the Background Fee. They will use the traditional "hierarchy" structure - only 2 levels - personal and sponsor.
At the moment - these Tests are being reimbursed based on which codes are being submitted based on what tests / procedures were preformed.
The test can be ordered by any Board Certified Physician. Mostly via TeleMedicine at the moment.
CMS is making the reimbursements via Medicare and also Medicade. Naturally, Medicade is paying less . . .
Private Insurance Carriers are coming onboard as well.
The difference is in whether or not a Marketing Company is compliant in their marketing, intaking, submission, etc . . .
Someone can not initiate the contact via phone, text, email, etc. The lead MUST be initiated by the Patients - via Events, Direct Mail, Commercials, etc - very similar to Part C and Part D.
It does pay very, very well depending on which Cancer Screen is used and the depth of the Patient and Family history is submitted upon intake. Crazy but a sick person with a sick family, especially death by cancer, pays more - primarily based on the coding that is submitted.
The 3 companies that I spoke with are jumping all in. Only one of them is going to do it right, in my opinion, by performing background checks on the Intake Specialists, using HIPPA certifications and seeking those in professional capacities - ie: Insurance Agents, Doctors, Nurses, etc.
Don't know how long the window of opportunity will be on this - may last may not. But - the process isn't a scam or illegal as some state. Now - the process of gathering the leads could be, depending on the methods.
2 of the 3 are using a MLM model and charging someone a fee to join as an Intake Specialist and then paying portions of that fee to the MLM sponsor. That will cause a red flag for sure . . .
The one that I am joining, is the one doing it right, doing the Background Check, etc. They only charge for the Background Fee. They will use the traditional "hierarchy" structure - only 2 levels - personal and sponsor.
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