Fraud in Genetic Testing: Swindling the System

Advisor: Claire N. Singletary, MS, CGC

Healthcare fraud comprises a sizable portion of the United States healthcare expenditure and inflicts strain on payors, patients, and the healthcare system overall. The genetic testing industry is rapidly growing which provides a multitude of fraud opportunities. There is limited research exploring genetic testing fraud, although federal organizations have highlighted it as an issue. This study identified 42 cases of fraud involving outpatient genetic testing that occurred between February 2019 and December 2023 via a literature review of federal websites, news articles, and a legal database. These cases were analyzed for themes via inductive conventional content analysis. 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. Examining fraudulent activity in genetic testing can help providers identify and report fraud, and provide awareness of fraud, waste, abuse and optimal healthcare allocation in the genetic testing industry.

Advisory Committee:
Claire N. Singletary, MS, CGC, Chair
Meagan Choates, MS, CGC
Molly Daniels, MS, CGC
Stephanie Gandomi, MS, CGC
Rebecca Lunstroth, JD, MA
Quinn Stein, MS, CGC

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