๐๐ฅ๐๐จ๐ ๐๐กย ๐๐๐๐ก๐๐๐๐๐๐๐ก๐๐ง๐๐๐ฆย &ย ๐๐๐ก๐ข๐ ๐๐๐ฆย ๐น๐ฎ๐ฏ๐: ๐ญ) ๐ฆ๐ฐ๐ถ๐ฒ๐ป๐๐ถ๐ณ๐ถ๐ฐ ๐ณ๐ฟ๐ฎ๐๐ฑ, ๐ฎ) ๐ฝ๐ฎ๐๐ถ๐ฒ๐ป๐ ๐๐ฎ๐บ๐ฝ๐น๐ฒ ๐ฟ๐ฒ๐ฐ๐ฟ๐๐ถ๐๐ถ๐ป๐ด ๐ณ๐ฟ๐ฎ๐๐ฑ, & ๐ฏ) ๐ฏ๐ถ๐น๐น๐ถ๐ป๐ด ๐ณ๐ฟ๐ฎ๐๐ฑ.
Do you work for aย Clinical Geneticsย orย Genomicsย laboratory that has a test that is reimbursed by theย Centers for Medicare & Medicaid Servicesย orย Commercial Health Insuranceย & you know that:
๐ญ) ๐ฆ๐ฐ๐ถ๐ฒ๐ป๐๐ถ๐ณ๐ถ๐ฐ ๐ณ๐ฟ๐ฎ๐๐ฑ: The lab has massaged, manipulated, falsified, or suppressed data about theย Clinical Testย to make the test look more accurate than it really is, or appear more clinically efficacious than it really is?
OR
๐ฎ) ๐ฃ๐ฎ๐๐ถ๐ฒ๐ป๐ ๐๐ฎ๐บ๐ฝ๐น๐ฒ ๐ฟ๐ฒ๐ฐ๐ฟ๐๐ถ๐๐ถ๐ป๐ด ๐ณ๐ฟ๐ฎ๐๐ฑ: 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).
OR
๐ฏ) ๐๐ถ๐น๐น๐ถ๐ป๐ด ๐ณ๐ฟ๐ฎ๐๐ฑ: 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 theย fraudย was used to achieve reimbursement fromย Medicaidย orย Medicare, please become aย Whistleblowerย by contacting theย 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 theย Clinical Geneticsย &ย Genomicsย industry & we really need insiders to help stamp it out.
Contact us at CGI to learn more.ย truth-in-genomics@genomicinterpretation.orgย or ph +1 (801) 810-4097.
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