A few days ago we flagged an OIG workplan about pathogen panel coding for > 5 pathogens (think 87798) - here.
OIG has another another molecular pathology workplan - this one focused on genetic tests.
The audit and report is expected to run 2026-2028. In particular, they will look for differences in payments between MOLDX and Non-MOLDX geographies.
Medicare Part B spending on genetic tests has been climbing steadily, with 2024 expenditures topping $3.6 billion—a half-billion-dollar increase over the previous year.
Genetic tests can harness the power of technological advancements to provide Medicare enrollees and their providers with valuable insight into disease risk, prevention, diagnosis, and treatment.
However, the rapid emergence of new tests and the higher average per-test payment amount can also make genetic tests vulnerable to fraud, waste, and abuse.
Prior work by OIG and its law enforcement partners has identified genetic testing fraud schemes involving deceptive telemarketing campaigns and kickbacks. This study will examine avenues for strengthening oversight of genetic tests covered under Medicare Part B, including identifying tests that may be vulnerable to fraud, waste, and abuse; assessing trends among laboratory test providers; and examining whether geographic variations exist, particularly between jurisdictions that do and do not participate in the Molecular Diagnostic Services Program.
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"Panels of 5" Project was announced 6/11, this one on genetics, announced on 6/15.
