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Trends and Vulnerabilities in Genetic Tests Covered Under Medicare Part B

Announced on  | Last Modified on  | Project Number: OEI-09-26-00270
Status
Active
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Medicare Part B spending on genetic tests has been climbing steadily, with 2024 expenditures topping $3.6 billion—a half-billion-dollar increase over the previous year.  Genetic tests can harness the power of technological advancements to provide Medicare enrollees and their providers with valuable insight into disease risk, prevention, diagnosis, and treatment; however, the rapid emergence of new tests and the higher average per-test payment amount can also make genetic tests vulnerable to fraud, waste, and abuse.  Prior work by OIG and its law enforcement partners has identified genetic testing fraud schemes involving deceptive telemarketing campaigns and kickbacks.  This study will examine avenues for strengthening oversight of genetic tests covered under Medicare Part B, including identifying tests that may be vulnerable to fraud, waste, and abuse; assessing trends among laboratory test providers; and examining whether geographic variations exist, particularly between jurisdictions that do and do not participate in the Molecular Diagnostic Services Program.

TIMELINE

  • June 15, 2026
    Announced
Work Plan Type
Office of Evaluation and Inspections
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Laboratories
Target Groups
-
Financial Groups
Medicare B