We may sometimes take for granted the protections we have in place. A well-established compliance program has controls to curb or eliminate instances of fraud, waste, and abuse in the form of a special investigations department, data analytics team, or fraud unit. They are charged with staying current with billing trends, vulnerabilities in systems, and new schemes targeting your membership.
In what I consider a new low, the public health emergency (PHE) has created an environment of new opportunity for scammers to defraud Medicare beneficiaries. Earlier this month, the Office of Inspector General provided new updates on COVID-19 fraud, outlining trends such as:
- Offers of COVID-19 tests in exchange for personal information
- A focus on retirement communities, offering COVID-19 tests but instead billing for unnecessary services
- Fake offers of prescription drug cards
- Other schemes showcased in OIG video alerts
In light of the PHE, think of how your most vulnerable members have been impacted. Did you increase supplemental benefits last year to assist your frail, confined, lonely members in hopes of improving their well-being? That was before COVID-19. Now imagine how isolated, nervous, and vulnerable they are. Family cannot visit and their social time with friends also has to be limited. We are experiencing a surge in positive cases in Rhode Island, so tougher restrictions were recently implemented. If scammers are aggressively calling, texting, using social media and even going door-to-door, we have to be good neighbors in every sense of the word.
Even if your fraud unit is up-to-date on these schemes, it is important that this information be shared. Leverage this information to inform your team members, your provider community, and your members. Last month I wrote about culture, so what better way to reinforce that commitment than to hear a leadership reiterate the organization’s commitment to your members, your neighbors? It takes no time to customize messaging for internal distribution, for a provider portal, for on-hold messaging, or for a member newsletter. You care about your community, so spread the word:
- Be wary of strange, unsolicited phone calls, emails, and visitors
- Do not share personal information with someone claiming to represent Medicare
- Work with your physician’s office or your state government on advice for COVID-19 testing
- Review your Part D Explanations of Benefit for suspicious activity
- When in doubt, report your suspicion online or by phone at (800) 447-8477
Ask your fraud unit what’s happening in your service area. They should know what local law enforcement has seen and how your members may be vulnerable. Tailor your community messaging with examples so it is relatable and understandable. Promote your own fraud unit’s contact information, and thank them for their extra work during this time.