covid-19 fwa fraud

On March 30th, 2020, the Secretary of the Department of Health and Human Services (HHS) issued nationwide blanket waivers of sanctions under the federal physician self-referral law (Stark Law) for “COVID-19 Purposes” (Blanket Waivers). While fraud waste and abuse laws are being relaxed, definitions of typical fraud areas such as referrals have become even more broad.

Why does fraud become more of a risk during uncertain times? Poor behavior ramps up as the economy spirals downward. Key personnel are being laid off and the typical work environment has switched to work from home, just to name two small change examples. It is clear to see how controls can breakdown while fraud risks increase.

Finding and working the fraud has also changed. Obtaining key points of investigations and audits is nothing like they were before. Performing common physical requirements are not the same, from inventory analysis, to interviews.

Thus, there is a perfect storm. There are new ways of working, laws are being relaxed, and both internal and external risks have increased greatly. Here are a few schemes that have been first to come to market:

  • Identity Theft
  • Businesses selling free testing and/or fake cures to obtain Medicare beneficiary information
  • Telemedicine
  • Documentation (upcoding time with patients)
  • Laboratory and Pharmaceutical
  • Sales of counterfeit or fake testing kits, cures, “immunity” pills, and protective equipment
  • Prescribing unproven “cure” drugs like chloroquine

We are here to talk through whatever issues you are seeing and develop what and how you should be looking them.