DNA cancer screening tables are a medicare scam

Dec 17, 2018

  1. craig_ritter
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    craig_ritter Guru

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    I don't have a dog in this fight, but this probably violates Anti-Kickback statute (42 USC 1320a-7b(b))

    Whoever knowingly and willfully solicits or receives any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind—in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility,service, or item for which payment may be made in whole or in part under a Federal health care program, shall be guilty of a felony and upon conviction thereof, shall be fined not more than $100,000 or imprisoned for not more than 10 years, or both.

    42 U.S. Code § 1320a–7b - Criminal penalties for acts involving Federal health care programs
     
  2. myinsurebiz
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    myinsurebiz Guru

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    I'm no Lawyer, but seems that Section 3 (c) (i) allows the payment . . .

    The fees are paid out by the labs.
     
  3. craig_ritter
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    craig_ritter Guru

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    I'm no Lawyer, either. Let's just say it's possible that it's legal and it's possible that it's a felony. Likely depends on who's billing Medicare, how they are billing Medicare, Medical necessity, etc.

    Here's one example of a similar case: Millennium Health Agrees to Pay $256 Million to Resolve Allegations of Unnecessary Drug and Genetic Testing and Illegal Remuneration to Physicians
     
  4. somarco
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    somarco That Medicare Expert Guy

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    You really missed the point of this thread, didn't you?
     
    somarco, Feb 10, 2019
    #74
  5. safeandsound
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    safeandsound New Member

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    Correct me if i am wrong. Isn't a SOA required and it can not be on the same day of the screen? I know this will lengthen the process but could be just a minor delay. I don't work in the MA market so not too familiar with SOA's but I have been approached and am curious.
     
  6. myinsurebiz
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    Not required. This isn't anything to do with Part C. A few companies are wanting the marketer to gather a SOA - but, no time restrictions on seeing the client.
     
  7. safeandsound
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    safeandsound New Member

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    So you are saying that if these companies require a SOA, you don't have to wait 48 hrs before seeing them regarding the screen? Also, If you are moving forward with your particular screening co, i would be interested in hearing more. Thanks for the insight.
     
  8. sshafran
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    sshafran Guru

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    One genetic test with risk is worth $700-900 depending on which post you see.

    Quick “easy money.”

    But it’s a gray area... likely, not viable long-term.

    I’ll let some agents pursue this and I’ll keep building my Medicare book. Each new client is worth $1,500+ LTV.

    Double the income, no risk of fraud.

    It’s really a no-brained for an agent which path to go all in on.
     
  9. benneaf
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    benneaf Expert

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    My upline tells me its set up so you call into a teledoc that does a "needs assessment" and then orders the test. It does sound a little fishy. My guess is it will last a few months, not even a year before they change the rules.
     
    benneaf, Feb 10, 2019
    #79
  10. Sethb2
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    I didn't not. I was trying to remind you that every new idea involving Medicare is never received with open arms. Mainly due to regulations. But at the same time be more open to new ideas, not every thing out there is a scam. Medicare is trying o find ways to save lives and money. Hence I talked about diabetics shoe as an example.
     
    Sethb2, Feb 11, 2019
    #80
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