𝗙𝗥𝗔𝗨𝗗 𝗜𝗡 𝗖𝗟𝗜𝗡𝗜𝗖𝗔𝗟𝗚𝗘𝗡𝗘𝗧𝗜𝗖𝗦 & 𝗚𝗘𝗡𝗢𝗠𝗜𝗖𝗦 𝗹𝗮𝗯𝘀: 𝟭) 𝗦𝗰𝗶𝗲𝗻𝘁𝗶𝗳𝗶𝗰 𝗳𝗿𝗮𝘂𝗱, 𝟮) 𝗽𝗮𝘁𝗶𝗲𝗻𝘁 𝘀𝗮𝗺𝗽𝗹𝗲 𝗿𝗲𝗰𝗿𝘂𝗶𝘁𝗶𝗻𝗴 𝗳𝗿𝗮𝘂𝗱, & 𝟯) 𝗯𝗶𝗹𝗹𝗶𝗻𝗴 𝗳𝗿𝗮𝘂𝗱.
𝟭) 𝗦𝗰𝗶𝗲𝗻𝘁𝗶𝗳𝗶𝗰 𝗳𝗿𝗮𝘂𝗱: The lab has massaged, manipulated, falsified, or suppressed data about the Clinical Test to make the test look more accurate than it really is, or appear more clinically efficacious than it really is?
𝟮) 𝗣𝗮𝘁𝗶𝗲𝗻𝘁 𝘀𝗮𝗺𝗽𝗹𝗲 𝗿𝗲𝗰𝗿𝘂𝗶𝘁𝗶𝗻𝗴 𝗳𝗿𝗮𝘂𝗱: Has the lab in the past, or at present, been recruiting patient samples in unusual ways? (For example, are they paying contractors to find them patient samples, often from the elderly, where the contractor is calling people at home & encouraging them to take their genetic test in person or by mail. Or is the contractor collecting saliva samples at health fairs, or is the contractor harvesting samples from nursing homes, senior living communities, or rehab centers? https://lnkd.in/gJbpE4Un).
𝟯) 𝗕𝗶𝗹𝗹𝗶𝗻𝗴 𝗳𝗿𝗮𝘂𝗱: Do you know if the lab was or is using billing codes they shouldn’t use, and there are more specific billing codes they should use instead? (For example, CPT code 81408 was used when there were more appropriate CPT codes that would have paid less? Or maybe CPT codes 81400 through 81407 were used when there were more appropriate codes? (See https://lnkd.in/eydg5Fth and Bruce Quinn‘s short YouTube Video https://lnkd.in/gm6VRDrX).
Or codes were or are being used to increase reimbursement when they shouldn’t have been used? Like in standard carrier screening it’s inappropriate for a lab to use CPT code 81223 for full CFTR gene sequencing when they should be using only 81220 for the US panethnic CFTR mutation panel. Or the lab was sometimes or always including CPT code 81222 for CFTR Dup/Del testing, which would be inappropriate for standard carrier screening. There are MANY more codes that carrier screening labs abuse. (Reach out to the nonprofit Center for Genomic Interpretation for more).
If the fraud was used to achieve reimbursement from Medicaid or Medicare, please become a Whistleblower by contacting the HHS Office of Inspector General.
If the fraud was used to achieve reimbursement from commercial health insurance only, (which is a common approach by lab leadership who don’t want to be arrested), then please contact us at the independent & nonprofit Center for Genomic Interpretation & we’ll help get the information to the right people.
Be BRAVE! Fraud is VERY common, VERY harmful, & VERY costly in the Clinical Genetics & Genomics industry & we really need insiders to help stamp it out.
Contact us at CGI to learn more. firstname.lastname@example.org or ph +1 (801) 810-4097.