Is it illegal for licensed insurance agents to process cancer screening test?

Jan 28, 2019

  1. myinsurebiz
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    myinsurebiz Guru

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    Those payouts are super low. More like $600 and $1500 to the Rep.
     
  2. Sethb2
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    Sethb2 Expert

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    I agree, but I was making the point that some companies have been doing this and taking advantage of those people doing the swab.

    Which company pays up to $1500? I will assume the more family members have cancer the more money?
     
    Sethb2, Feb 11, 2019
    #22
  3. myinsurebiz
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    myinsurebiz Guru

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    The greater the "coding", the greater the money.

    I think you even get an additional code if your dog or cat's family had a history of cancer j/k
     
  4. NormMitchell
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    NormMitchell New Member

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    Don't be blinded by the potential of easy money. This opportunity was documented to the State Health Insurance Assistance Program (SHIP -https://acl.gov/programs/connecting-people-services/state-health-insurance-assistance-program-ship) who confirmed in an Email that it was considered fraud/scam and they forwarded the information to the Inspector General's Office for further review, investigation, and processing. Where the problem arises is two-fold, 1st the referral to a physician outside the Medicare recipients primary physician (yeah I know myinsurebiz you say you can't find anything which states that's illegal but pull your head out of your ass and think about it a moment in relation to this next part) and 2nd: The Anti Kickback Statute (AKS) is a criminal law that prohibits the knowing and willful payment of "remuneration" [[[[[[to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients).]]]]]] Remuneration includes anything of value and can take many forms besides cash, such as free rent, expensive hotel stays and meals, and excessive compensation for medical directorships or consultancies. In some industries, it is acceptable to reward those who refer business to you. [[[[[[[However, in the Federal health care programs, paying for referrals is a crime.]]]]] The statute covers the payers of kickbacks-those who offer or pay remuneration- as well as the recipients of kickbacks-those who solicit or receive remuneration. Each party's intent is a key element of their liability under the AKS. (This is the link: https://prd-medweb-cdn.s3.amazonaws.com/documents/DCCI/files/Anti-Kickback Statute.pdf). Now I don't know what they are calling the payment you receive from whoever is paying you (referring doctor, labs doing testing, your upline, whoever), but it is nothing more than a KICKBACK paid to you for referring that Medicare recipient. It's really not rocket science if you step back and take a focused look at it.
     
  5. Sethb2
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    Wow! Long paragraph makes it difficult to follow this important message you are trying to convey.
     
    Sethb2, Feb 11, 2019
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  6. somarco
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    somarco That Medicare Expert Guy

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    Based on your comments in this thread, would it make any difference if @NormMitchell broke it down into paragraphs and sub-headings?
     
    somarco, Feb 11, 2019
    #26
  7. Sethb2
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    To other people it would.
    I see Somarco you're in my case.
     
    Sethb2, Feb 11, 2019
    #27
  8. myinsurebiz
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    myinsurebiz Guru

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    I've been at my boys Baseball games today on the road, so just got home. I received this email from my Attorney:

    Tom,

    Based on the links that you provided me, my consult is to advise you to not participate in the marketing of the Cancer / DNA screens that you mentioned. It has more risk than reward, not to mention the potential legalities that could or could not be criminal.

    You may wish to thank Mr. Ritter for sharing his findings with you. Probably saved your career.

    Sincerely,

    Seymour

    So - thanks @craig_ritter
     
  9. NormMitchell
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    NormMitchell New Member

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  10. Northeast Agent
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