COVID Feature: Rolling Into Fraud

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Stethoscope on 100 dollar bills symbolizing financial surveillance

The coronavirus pandemic has led to an increase in people registering with state Medicaid programs, which has corresponded with a spike in Medicaid related fraud.

Medicaid fraud can take many forms as fraudsters pour their creativity into preying on the most vulnerable among us. One common fraud comes from labs that are supposed to be administering and processing COVID-19 tests. The lab will issue a medically unnecessary respiratory pathogen panel (RPP) test in addition to the standard coronavirus test. This allows the labs to illegally bill Medicaid at higher rates. Worse yet, the labs often do not process the results.

These schemes are often done in conjunction with telemedicine companies or marketing organizations that illegally profit from up-charging schemes. (Their priority isn’t to provide the best care, but to make the most money.) Telemedicine companies may view the potential for kickbacks as an incentive for ordering unnecessary tests. The fraudsters realize that when multiple participants work together to commit Medicaid fraud, it can become more difficult to detect.

Another tactic is to call Medicaid beneficiaries and attempt to lure personal information from them. These scammers will offer free COVID-19 tests and ask them to provide verification of their enrollment status. This includes asking for their personal identification numbers which can be used to commit identity theft. The fraudsters will then use the information to bill Medicaid on the beneficiaries’ behalf for equipment or services that never occurred. (Schemers can make hundreds to thousands of dollars by exploiting the government system.)

Medicaid beneficiaries should be wary of calls offering free COVID-19 testing or medical services. You should never provide personal identification numbers or financial information to callers.

People are encouraged to only seek medical treatment through their own, trusted healthcare professionals, who can provide treatment or direction on where to receive COVID-19 testing. Also, accredited testing sites can be found through each state’s Department of Health website.

Anyone who believes they have been a victim of Medicaid fraud during the COVID-19 pandemic should contact the Medicaid Fraud and Abuse Hotline at 1-877-ABUSE TIP. 

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Today’s Fraud of the Day comes from an article, “Expanded Medicaid Rolls Lead to Scam Warning,” posted on wtvq.com on April 14, 2020.

FRANKFORT, Ky. (WTVQ) – With more people on the state’s Medicaid rolls because of the coronavirus epidemic, state leaders are issuing warnings about scammers trying to take advantage.

During the COVID-19 pandemic, scammers may target Medicaid beneficiaries in order to illegally bill the Medicaid program for unnecessary services and equipment related to coronavirus testing and treatment, said Attorney General Daniel Cameron.

 

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.