[Fraud Trends Series] Trend #4: Healthcare Fraud

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Stethoscope on 100 dollar bills symbolizing financial surveillance

While healthcare fraud has been around for a long time, the COVID-19 pandemic certainly opened up a Pandora’s Box of new scams. Using tried and true techniques, fraudsters managed to steal billions of dollars from U.S. healthcare insurance programs such as Medicare and Medicaid. During a time when many were pulling together to help each other, nefarious individuals were and are still calculating how to go after U.S. Government health benefits and vulnerable citizens in order to fatten their bank accounts.

While traditional types of healthcare fraud such as billing for services not rendered, submitting duplicate claims, paying kickbacks, and upcoding are still prevalent, other scams relying on the fears of Americans have excelled. The U.S. Department of Health and Human Services’ (HHS) Office of Inspector General warns the public about how perpetrators are carrying out fraud schemes related to the novel coronavirus through testing sites, telemarketing calls, text messages, social media platforms, and door-to-door visits. Fraudsters typically offer COVID-19 services in exchange for personal details, like Social Security Numbers or Medicare or Medicaid beneficiary numbers, that can be used to fraudulently bill government health care programs and commit medical identity theft.

For a better understanding of how COVID-19-related healthcare fraud schemes have evolved over the past two years, take a look at these high dollar cases:

These are only three cases involving COVID-19 related healthcare fraud. You can expect to see even more as we either emerge from the pandemic or continue to experience different variants of the virus. (Let’s hope it’s the former.)

Just keep in mind that scammers love to prey on COVID-19 fears. (We’re not exactly out of the woods yet.) If anyone offers you a test or cure in exchange for personal information, run away. (No, really. Run.) If you don’t recognize the phone number don’t pick up the call. Don’t respond to any texts with hyperlinks. (In fact, block the number.) Refrain from clicking on any social media ads (and don’t answer the door when anyone you don’t recognize comes a knockin’.)

COVID-19 healthcare fraud is fast evolving. Reach out to your doctor or medical community if you have questions about COVID-19 testing or treatments, not someone trying to sell you “snake oil.” And last, but not least, if you suspect healthcare fraud of any type, take action. Report it online at OIG.HHS.gov or call 1-800-HHS-TIPS (447-8477).

 

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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.