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, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.