How to Easily Promote Fraud Awareness during COVID-19

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. 

Communications Accessibility: Best Practices Released by CMS

On April 26, 2019, the Centers for Medicare & Medicaid Services (CMS) released Communications Accessibility for Individuals with Disabilities – Best Practices for Medicare Health and Part D Prescription Drug Programs. This document was submitted to the agency by IMPAQ International, LLC. The report focuses on auxiliary aids and services addressing communication-related accessibility needs, as those cover typical beneficiary interactions.

About a year and a half ago, some colleagues and I authored a white paper titled Accessible Communications: Standing Tall in Service. We realized the importance of this topic as the agency had released frequently-asked questions related to Section 504 of the Rehabilitation Act of 1973 (Section 504) and Section 1557 of the Affordable Care Act (Section 1557). I’m happy to report many of our recommendations and best practice concepts are also found in the IMPAQ piece, such as cultural competency training, leveraging qualified readers, tracking/maintaining beneficiary requests, analysis of complaint data, and auditing/monitoring of vendors. IMPAQ covers more in the arena of web accessibility, whereas I respectfully believe we covered more from a delegation oversight standpoint.

The reason we wrote this piece was because our number one priority was beneficiary access to care and service. I know for a fact the piece was not as popular as anything related to CMS program audits or marketing materials. Now that CMS has released these best practices, plans and delegates should sit up and take more notice of this topic. This could be a harbinger of things to come.