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Fraud in genetic testing: Swindling the system.

Rachel Notestine1, Claire N Singletary2, Meagan Choates3

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Health care fraud is a growing problem in genetic testing. This study analyzed 42 cases, revealing common fraudulent schemes and their consequences, emphasizing the need for expert oversight in genetic testing claims.

Keywords:
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Area of Science:

  • Medical Economics
  • Forensic Science
  • Genetics

Background:

  • Healthcare fraud constitutes a significant portion of US healthcare spending, impacting payers, patients, and the overall system.
  • The expanding genetic testing industry presents increasing opportunities for fraudulent activities.
  • Despite federal attention, research on genetic testing fraud remains limited.

Purpose of the Study:

  • To investigate and identify prevalent themes and characteristics of health care fraud within the genetic testing sector.
  • To analyze the methods used in genetic testing fraud and the subsequent repercussions.
  • To inform healthcare providers and stakeholders about identifying and preventing genetic testing fraud.

Main Methods:

  • A retrospective review of 42 cases of outpatient genetic testing fraud.
  • Data sourced from federal websites, news articles, and a legal database.
  • Inductive conventional content analysis to identify themes in fraudulent activities.

Main Results:

  • Identified fraudulent themes: fraudulent claims, kickbacks, lack of patient contact, improper billing/documentation, and concealment tactics.
  • Consequences for perpetrators included monetary penalties, imprisonment, business restrictions, and property seizure.
  • Medically inappropriate testing was frequently observed in fraud cases.

Conclusions:

  • The prevalence of medically inappropriate testing underscores the critical role of genetics experts in ordering and reviewing genetic testing claims.
  • Understanding genetic testing fraud patterns aids providers in detection and reporting.
  • Analysis contributes to awareness for optimal resource allocation within the genetic testing industry.