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.

As we have progressed over the past several months for billing, coding, and changes in the rules and regulations concerning COVID-19, and the fraud, waste, and abuse scams have increased exponentially, so to have the prosecutions. In my home area, the US Attorney’s Office for the District of New Jersey, and my old office at the OIG, have been extremely busy investigating and prosecuting these frauds. The one prevailing issue that has continued to surface is the continued targeting of the Medicare population through social engineering and phishing to obtain PHI and PII to commit the fraud. CMS and the OIG have been on a public relations tear to continue to educate the Medicare population on taking the appropriate steps to protect their identities and the sharing of that very valuable information. 

I relate this in part, to the expansion to telemedicine and telehealth. The amazing expansion, something those in the healthcare insurance world have never seen before, is only effective for those who can access and utilize that technology. Seniors who are not necessarily able to utilize the expansion of telemedicine, may or may not even be in a position to see the warnings and education that is out there for the same population. This is all merely speculation. For every Medicare beneficiary who does have access to technology, uses it, understands it, etc., there are going to be an unknown number of the same population that has no access or ability to use telemedicine. 

The rhetorical, but practical question is whether or not the Medicare population is receiving the information about the social engineering scams. The second part of the rhetorical, but practical question, is whether or not the message is lost on them. I would say that it is a combination of both, as the prosecutions for these scams continue to be seen in the press releases. Are the frauds being perpetrated by unscrupulous providers who were already committing fraud, or are they new crooks making their way into the system? I also believe that this a combination of both. 

COVID-19 has afforded opportunities, both good and bad. Expanded healthcare delivery opportunities, the ability of companies to understand and identify that working remotely has a lot of positive collateral effects, and a host of other things that are still likely to surface. But as with everything, there is usually bad with the good. Unscrupulous providers will continue to attempt to make in-roads on their existing fraud schemes, new frauds will be uncovered, and frauds we do not even know about will begin to percolate up. 

Speak to seniors you know about these issues and educate them. They may know how to text and do FaceTime, but that does not mean they fully understand the nuances of being socially engineered. 

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.