Update – Help Consumers Avoid Genetic Testing Fraud
Over the last couple of weeks, UnitedHealthcare has received questions from agents like you about genetic testing companies offering to pay agents to promote genetic testing services to Medicare beneficiaries. You are an advocate for your members and consumers, and we want to provide you with information that helps protect consumers from potential health care fraud. We also want to bring awareness of our policies for when you are dealing with organizations with which UnitedHealthcare does not have an affiliation.
Here is what you need to know
UnitedHealthcare agents may not promote genetic testing services to UnitedHealthcare members and/or consumers. UnitedHealthcare is prohibiting this activity for a number of reasons:
- CMS Marketing Rules - CMS prohibits health screenings, like genetic testing, at marketing events because they can be perceived as cherry picking.
- UnitedHealthcare Producer Agreement/Policies - Under the UnitedHealthcare producer agreement, sales agents may not:
- Act on behalf of UnitedHealthcare in promoting genetic testing services to members or consumers
- Use our member PHI or UnitedHealthcare lead information to promote genetic testing services
- Make representations about whether particular testing is covered by UnitedHealthcare
- Steer UnitedHealthcare members to obtain tests through particular providers/labs based on financial interests
- Anti-Kickback Law - Based on the information provided to UnitedHealthcare to date, we are concerned that some genetic testing companies appear to be paying agents to make a referral for medical testing that will be paid for by Medicare. These kinds of arrangements may implicate the Federal Anti-Kickback Statute.
If we learn of any activities by agents using UnitedHealthcare information or targeting of UnitedHealthcare members or consumers for the purpose of promoting genetic testing, we will take all appropriate action, which may include terminating an agent’s producer agreement.
Questions
If you have questions or would like to report concerns about offers received to work with genetic testing companies, contact the Compliance mailbox at compliance_questions@uhc.com.
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