Healthcare Fraud Shield’s Latest Article: Be on the lookout for COVID-19 FWA

23 Jun
Amid the COVID-19 pandemic, fraud schemes continue to emerge and develop. While there is currently no FDA-approved vaccine for COVID-19 and although there may be treatments for symptoms, there is no cure at this time. Fraudsters often use fear-based tactics to convince people that a vaccine or cure is now being offered. 

With a new COVID-19 dashboard and nearly 60 custom Alerts specific to COVID-19 fraud, Healthcare Fraud Shield’s team of expert’s remain vigilant in monitoring, analyzing, and investigating current and future fraud schemes and trends. 
Our research shows that two of the highest targeted areas of COVID-19 fraud are Telemedicine and Off-label drug dispensing.

Telemedicine
  • With an increased push for telehealth and relaxed regulations, check your respective policies.
  • Does the patient have an existing relationship with the submitting or referring provider?
  • Is there an excessive increase in claim submissions other than what would be expected?
  • Are the services submitted actually the services provided?
  • Is the provider billing the correct codes and adding the correct modifiers?
  • How many visits is the provider billing in a day? Is that feasible?
  • Look at the location codes billed for a provider’s services submitted in a day, do they make sense?
  • Are they properly and consistently waiving copays/deductibles or is it sporadic and possibly a kickback?
As drugs continue be reviewed and granted or revoked Emergency Use Authorizations (EUA), below are some examples of what to look for[1]:

Off-Label use
  • What is the drug classified to treat? What diagnoses are found in the patient’s history and are they COVID-19 related?
  • Review pharmacies dispensing these drugs. Is there an exponential increase in the number of new prescriptions for these drugs?
  • Who is the prescriber? Does it make sense that they are prescribing this drug?
  • Is there an existing relationship between the patient and prescriber?
  • Does the pharmacy typically receive the majority of requests for this drug from the same provider or provider group?
  • Does the prescriber have the same last name as the patient?
Other potential schemes in healthcare related to COVID-19 include:
  • Hoarding and price gouging of critical supplies (masks, gloves, thermometers, alcohol wipes, hand sanitizer, rubbing alcohol)
  • Self-Prescribing (medical and dental providers prescribing and/or hoarding clinical trial medications for themselves and/or relatives)
  • Spike in DME equipment (nebulizers, respiratory equipment)
  • Spike in Telehealth/telemedicine visits (dental, behavioral health, rehabilitation, optometry)
  • Laboratory Testing (unnecessary tests, excessive units)
  • Alternative Treatments – See Websites[2] offering fake cures, vaccines, and advice on unproven treatments for COVID-19 (Colloidal Silver, Elderberry Elixirs, Reishi Immunity Broth, Kudzu root, Vitamin C/D, Skullcap, Astragalus Immunity
  • Upcoding (Billing for services that have a higher reimbursement than the service that was actually provided

Consumers can report any suspected fraudulent activity involving COVID-19 to the National Center for Disaster Fraud Hotline (866) 720-5721 or disaster@leo.gov.

If you have any questions or comments, please contact SIU@hcfraudshield.com.

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