Fraud in Genetic Testing: Swindling the System.

IF 6.6 1区医学 Q1 GENETICS & HEREDITY Genetics in Medicine Pub Date : 2024-09-03 DOI:10.1016/j.gim.2024.101248

Rachel Notestine, Claire N Singletary, Meagan Choates, Stephanie Gandomi, Molly Daniels, Rebecca Lunstroth, Quinn Stein

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Abstract

Purpose: Healthcare fraud comprises a sizable portion of United States healthcare expenditure and inflicts undue burden on payors, patients, and the healthcare system overall. The genetic testing industry is rapidly growing which propagates opportunities for healthcare fraud. Although federal organizations have highlighted it as an issue, there is limited research exploring genetic testing fraud.

Methods: A retrospective review of federal websites, news articles, and a legal database resulted in 42 cases of fraud involving outpatient genetic testing published between February 2019 and December 2023. These cases were analyzed for themes via inductive conventional content analysis.

Results: Themes of fraudulent activity included submission of fraudulent claims, kickback or bribe payments, minimal or no contact with patients for which testing was ordered, inappropriate billing and documentation practices, and further actions to conceal fraud. Repercussions imposed on defendants included monetary penalty, imprisonment, business restrictions, and seizure of property.

Conclusion: High rates of medically inappropriate testing in fraud cases highlight the value of genetics experts in ordering or reviewing claims for genetic testing. Examining fraudulent activity in genetic testing can help providers identify and report fraud, and provide awareness of optimal healthcare allocation in the genetic testing industry.

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基因检测中的欺诈：诈骗系统。

目的：医疗欺诈占美国医疗支出的很大一部分，给付款人、患者和整个医疗系统造成了不必要的负担。基因检测行业发展迅速，为医疗欺诈提供了可乘之机。尽管联邦机构已将此问题列为重点问题，但有关基因检测欺诈的研究却十分有限：方法：对联邦网站、新闻报道和法律数据库进行回顾性审查，结果发现在 2019 年 2 月至 2023 年 12 月期间发布了 42 起涉及门诊基因检测欺诈的案例。通过归纳式常规内容分析对这些案例进行了主题分析：欺诈活动的主题包括提交虚假索赔、支付回扣或贿赂、极少或根本不与接受检测的患者接触、不恰当的计费和记录做法，以及进一步隐瞒欺诈行为。对被告的处罚包括罚款、监禁、业务限制和没收财产：在欺诈案件中，医疗不当检测的比例很高，这凸显了遗传学专家在开具或审查基因检测索赔时的价值。审查基因检测中的欺诈活动可以帮助医疗服务提供者识别和报告欺诈行为，并为基因检测行业提供最佳医疗分配意识。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Genetics in Medicine 医学-遗传学

CiteScore

15.20

自引率

6.80%

发文量

857

审稿时长

1.3 weeks

期刊介绍： Genetics in Medicine (GIM) is the official journal of the American College of Medical Genetics and Genomics. The journal''s mission is to enhance the knowledge, understanding, and practice of medical genetics and genomics through publications in clinical and laboratory genetics and genomics, including ethical, legal, and social issues as well as public health. GIM encourages research that combats racism, includes diverse populations and is written by authors from diverse and underrepresented backgrounds.