Since early 2020, coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has significantly shaped public life and healthcare delivery across the country. The impactful nature of the virus led to necessary comprehensive changes in the nation’s healthcare system. As a result of these changes, potential vulnerabilities have been identified that enabled bad actors to adapt previously existing healthcare fraud, waste, and abuse schemes. In response, the Healthcare Fraud Prevention Partnership (HFPP), detailed below, has released its latest white paper titled, “Fraud, Waste, and Abuse in the Context of COVID-19”.
The HFPP is a voluntary public-private partnership whose members work to identify and prevent fraud, waste, and abuse across the healthcare sector. HFPP Partners include federal government, state agencies, law enforcement, private health insurance plans, and health care anti-fraud associations. These HFPP Partners represent approximately 75% of covered lives in the United States. The ultimate goal of the HFPP is to stop waste, fraud, and abuse before they even start—and before healthcare dollars are lost or stolen.
The goal for this white paper, developed with direct input from HFPP Partners and in collaboration with researchers from Stanford University’s School of Medicine, is to first provide a foundational background on COVID-19, efforts to test for and treat the virus, and the changes to practices and policies implemented to improve the delivery of healthcare during the Public Health Emergency (PHE). The paper then highlights trending fraud schemes including billing for potentially unnecessary services, incorrect coding and billing, and direct solicitation and identify theft. Finally, the white paper offers strategies and actions for healthcare payers to consider and apply. Described methods include:
• Increasing collaboration with stakeholders and using focused data analytics to speed and bolster detection efforts
• Taking and supporting enforcement actions through increased communication with and amongst law enforcement about identified vulnerabilities
• Educating providers about policy changes and members, beneficiaries, and patients on best practices to prevent fraud, waste, and abuse
Broadly, this white paper outlines important steps that federal and state agencies, private payers, and law enforcement have taken in identifying and responding to fraud, waste, and abuse related to the delivery of care for COVID-19. These actions and lessons learned may allow these parties to anticipate vulnerabilities moving forward, providing a foundation for navigating a changed healthcare landscape and future challenges.