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Trends in Genetic Tests Provided Under Medicare Part B Indicate Areas of Possible Concern

See Also: Fraud Alert: Genetic Testing Scam

Our analysis of nationwide trends in genetic testing under Medicare Part B showed that payments for genetic tests, the number of genetic tests performed, the number of laboratories that received more than $1 million for performing genetic tests, and the number of providers ordering genetic tests for beneficiaries all increased during our audit period (calendar years 2016 through 2019). Although there are legitimate reasons that genetic testing has increased, these increases indicate areas of possible concern, such as excessive genetic testing and fraud, which may negatively affect beneficiaries. In addition, Medicare requirements and guidance related to coverage of genetic testing have been limited and have varied among Medicare Administrative Contractor (MAC) jurisdictions. Oversight by the Centers for Medicare & Medicaid Services (CMS) and the MACs is critical to prevent fraud, waste, and abuse related to genetic testing and to protect Medicare beneficiaries. The information in this data brief may help CMS and other stakeholders to identify changes in the Medicare program, such as increased oversight, that could prevent fraud, waste, and abuse and protect Medicare beneficiaries.

Because this report contains no recommendations, CMS did not provide written comments on our draft report but did provide technical comments, which we addressed as appropriate.

Filed under: Centers for Medicare and Medicaid Services