A Lucrative Opportunity

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Stethoscope on 100 dollar bills symbolizing financial surveillance

New data in a recent analysis from the Department of Health and Human Services’ Office of Inspector General shows that Medicare spending on testing for the COVID-19 virus continues to increase in 2022. In fact, as of October 31, 2022, Medicare has spent as much as it did all of 2021, coming in at $2 billion. Why? Because testing numbers are going up due to increasing COVID-19 numbers? Because more testing is required for the safety of Americans? No. It appears the increased spending in COVID-19 testing is because of fraud. And it looks like those numbers will keep increasing.

Early in the pandemic, it was deemed essential for COVID testing to slow the spread of the virus, but the ability to meet the demand was not there. So to get those testing sites up and running, the federal government enacted measures to make it more profitable to get into the COVID-19 testing business, including a generous Medicare reimbursement rate and coverage for the uninsured. Also, federal money used to kick off testing for healthcare providers and laboratories was not subject to some of the same regulatory constraints as other tests covered by Medicare. Testing became a very lucrative opportunity, with the U.S. Government opening it’s checking account for all who were interested.

The loosened measures succeeded in drawing new and existing labs into the COVID-19 business but also attracted fraudsters. Of course.

But despite boosted availability of testing across the country, the government hasn’t made any revisions in policy and regulations making it easy for fraud to continue at horrifying numbers. The analysis done by the HHS Office of Inspector General shows COVID-19 testing fraud schemes have grown and included testing for those without symptoms, billing for services not provided, and even subscription plans for over-the-counter tests. Tolerating some fraud may be a necessary trade-off to attain legitimate public policy goals (it’s really not!), but when the goals are met and the reimbursement policies are still unrestricted, the fraudster is getting more benefits than the U.S. taxpayer.

Kudos to the Department of Health and Human Services’ Office of Inspector General with this much needed analysis.

Today’s Fraud of the Day is based on an article “Medicare Keeps Spending More on COVID-19 Testing. Fraud and Overspending Are Partly Why” Published by ProPublica on December 30, 2022

As the COVID-19 pandemic continues to churn, Medicare spending on testing for the virus continued to increase in 2022 and is outpacing the two prior years.

Through Oct. 31, Medicare had spent $2 billion on COVID-19 tests in 2022, an amount that will surpass last year’s total as claims are filed, according to new data provided to ProPublica by CareSet, a research organization that works to make the health care system more transparent.

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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.