Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes.

With every single social media post out there is about Coronavirus (and just out of curiosity, why does everyone now refer to it as COVID-19, as if we are all lab techs?), I am going to continue to discuss the world of fraud, waste, abuse and compliance.  As many of you know, CMS has made some very unprecedented changes, albeit temporary, to the manner in which providers can submit claims for reimbursement.  Additionally, in my long career at the OIG, I have never seen such swift notification to the public about fraud schemes, including the standing up of a website specifically for the purpose of filing a complaint as it relates to the Coronavirus.

We are living in uncharted territory with fraud, waste and abuse going forward.  It is not just about coding and manipulation of existing and new codes.  It is the bogus emails, phone calls, mailings, and the constant peppering of people using fear mongering that are going to prey upon the Medicare population.  Many have probably seen or read about the elderly couple in Arizona who took a fish tank grade medication that is similar to a human drug for malaria and died as a result.  These are truly strange and sad times.  The billing and coding frauds will begin to show visibility for months, if not years, to come.  The bigger issue will certainly be the inordinate number of Medicare beneficiaries that will be preyed upon to provide their personal information in ways that they perceive are going to provide them with protection and better health.

Some of the more obvious schemes are going to be manipulation of the DRG seeking higher reimbursement for the Coronavirus treatment.  From a testing perspective, the Medicare program pays about $16 for a flu test, whereas the Coronavirus test is reimbursing over $50.  Everyone is going to be tested for Coronavirus.

I am keeping this week’s blog short and sweet, only because everyone is talking about this virus, posting about it, providing their interpretations of the CMS relaxing of the rules and regulations, various legal and coding opinions of what this all means for the provider, etc.  Spend more time being safe.  Spend more time washing things that touch things.  Spend more time working to be healthy and less time reading the incessant posts, news articles, rhetoric and general shenanigans about the current state of heath affairs.

Be safe, we will all be ok.

Advize Health LLC is a healthcare advisory and consulting company that provides a breadth of healthcare industry services in the payer, provider, and legal communities. Contact Eric Rubenstein for more information on our Fraud Spotlight series.