{"id":57299,"date":"2021-12-22T17:18:00","date_gmt":"2021-12-22T17:18:00","guid":{"rendered":"https:\/\/www.dinsmore.com\/?post_type=publications&#038;p=57299"},"modified":"2025-11-24T20:40:21","modified_gmt":"2025-11-24T20:40:21","slug":"oig-report-highlights-focus-on-fraud-with-genetic-tests","status":"publish","type":"publications","link":"https:\/\/www.dinsmore.com\/publications\/oig-report-highlights-focus-on-fraud-with-genetic-tests\/","title":{"rendered":"OIG Report Highlights Focus on Fraud with Genetic Tests"},"content":{"rendered":"\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/www.dinsmore.com\/wp-content\/uploads\/2021\/12\/Genetics-Banner.jpg\" alt=\"\"\/><\/figure>\n\n\n\n<p>On Dec. 21, 2021, the Office of Inspector General (OIG) released a Health &amp; Human Services (HHS) <a href=\"https:\/\/oig.hhs.gov\/oas\/reports\/region9\/92003027.pdf\">OIG Data Brief<\/a> on genetic tests provided under Medicare Part B. The goal of the OIG in reviewing this data was \u201cto analyze nationwide trends in genetic tests provided and payments made under Medicare Part B.\u201d<a href=\"#_ftn1\" id=\"_ftnref1\">[1]<\/a> As a result of this analysis, the OIG determined that there is a significant risk of overuse and misuse of genetic testing. Healthcare organizations that process genetic tests should conduct audits to ensure that the charges they submit for such tests are appropriate.<\/p>\n\n\n\n<p>The OIG\u2019s study reviewed approximately $3 billion in Medicare payments for 5.1 million genetic tests that were reimbursed from Jan. 1, 2016, to Dec. 31, 2019. The OIG\u2019s analysis found that the average beneficiary received 2.16 genetic tests over the time period of the study. While 2.16 tests may be the average, the OIG also discovered that \u201cof the 2.4 million beneficiaries that received at least one genetic test during that period, more than 67,000 beneficiaries received 10 or more different genetic tests, and more than 3,000 received 20 or more different genetic tests.\u201d<a href=\"#_ftn2\" id=\"_ftnref2\"><sup>[2]<\/sup><\/a><\/p>\n\n\n\n<p>In fact, during the OIG\u2019s audit period \u201ctotal Medicare payments to laboratories for genetic tests quadrupled.\u201d<a href=\"#_ftn3\" id=\"_ftnref3\"><sup>[3]<\/sup><\/a> The OIG relied on these data points to draw the conclusion that some portion of the genetic tests that are being ordered are likely excessive and therefore an area of focus for the OIG for potential fraud. The OIG in its analysis discovered three main categories of fraudulent billing: (1) billing for services not provided or performed; (2) unbundling of claims; and (3) blanket ordering.<a href=\"#_ftn4\" id=\"_ftnref4\">[4]<\/a>&nbsp;<\/p>\n\n\n\n<p>The OIG\u2019s Data Brief is a continuation of its efforts to focus on fraud with genetic testing. In September 2019, the OIG issued a <a href=\"https:\/\/oig.hhs.gov\/fraud\/consumer-alerts\/fraud-alert-genetic-testing-scam\/\">fraud alert<\/a> on genetic testing. The OIG has also been ramping up its enforcement efforts with respect to genetic testing. Due to recent OIG diligence and monitoring of this area, the \u201cOIG and its law enforcement partners charged 35 individuals for their alleged participation in genetic-testing fraud schemes, involving $2.1 billion in losses to the Medicare Program.\u201d<a href=\"#_ftn5\" id=\"_ftnref5\">[5]<\/a><\/p>\n\n\n\n<p>If you or your organization may be impacted by the audit findings or are interested in learning how to comply with the issues raised by the audit, please contact Dinsmore\u2019s health care practice attorneys.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><a href=\"#_ftnref1\" id=\"_ftn1\">[1]<\/a> HHS OIG Data Brief (2021, December 21) <em>Trends in Genetic Tests Provided Under Medicare Part B Indicate Areas of Possible Concern <\/em><a href=\"https:\/\/oig.hhs.gov\/oas\/reports\/region9\/92003027.pdf\"><em>https:\/\/oig.hhs.gov\/oas\/reports\/region9\/92003027.pdf<\/em><\/a><\/p>\n\n\n\n<p><a href=\"#_ftnref2\" id=\"_ftn2\">[2]<\/a> <em>Id<\/em>. at 12.<\/p>\n\n\n\n<p><a href=\"#_ftnref3\" id=\"_ftn3\">[3]<\/a> <em>Id<\/em>. at 16.<\/p>\n\n\n\n<p><a href=\"#_ftnref4\" id=\"_ftn4\">[4]<\/a> <em>Id<\/em>. at 14.<\/p>\n\n\n\n<p><a href=\"#_ftnref5\" id=\"_ftn5\">[5]<\/a> <em>Id<\/em>. at 13.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>On Dec. 21, 2021, the Office of Inspector General (OIG) released a Health &amp; Human Services (HHS) OIG Data Brief on genetic tests provided under Medicare Part B. The goal of the OIG in reviewing this data was \u201cto analyze nationwide trends in genetic tests provided and payments made under Medicare Part B.\u201d[1] As a\u2026<\/p>\n","protected":false},"author":8,"featured_media":0,"menu_order":0,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"tags":[],"publication-type":[8],"class_list":["post-57299","publications","type-publications","status-publish","format-standard","hentry","publication-type-articles"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v26.5 (Yoast SEO v26.9) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>OIG Report Highlights Focus on Fraud with Genetic Tests - Dinsmore &amp; Shohl<\/title>\n<meta name=\"description\" content=\"OIG Report Highlights Focus on Fraud with Genetic Tests Read insights and legal analysis from attorneys at Dinsmore &amp; Shohl LLP.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.dinsmore.com\/publications\/oig-report-highlights-focus-on-fraud-with-genetic-tests\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"OIG Report Highlights Focus on Fraud with Genetic Tests\" \/>\n<meta property=\"og:description\" content=\"OIG Report Highlights Focus on Fraud with Genetic Tests Read insights and legal analysis from attorneys at Dinsmore &amp; 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