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Compliance: Cancer Genome Testing

 In Agent Updates, Compliance

Updated March 11, 2019

Bottom line

There has been a lot of buzz lately about a program being offered to agents to assist clients with a genetic cancer screening. Agents are being offered a generous commission for each client helped.

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.

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