Gov't officials warn about coronavirus-related fraud

ATLANTA - The government is already seeing fraudulent scams related to the coronavirus pandemic, says Wayne van Halem, including, unfortunately, a scam involving DMEPOS.

van Halem, an Accredited Healthcare Fraud Investigator and Certified Fraud Examiner, recently participated in a webinar hosted by the National Healthcare Anti-fraud Association, during which special agents from the Office of Inspector General/Office of Investigations reported Medicare beneficiaries are being told in unsolicited phone calls that they are required to have COVID-19 tests and must provide their Medicare numbers. Two weeks later, they say, these beneficiaries receive DMEPOS, usually orthotic braces.

Here's what van Halem, president of The van Halem Group, had to say about how CMS might have opened Pandora's Box in its attempt to remove obstacles to care during the pandemic.

HME News: Why are we seeing increased fraud during the pandemic?

Wayne van Halem: There have been all of these safeguards in place (to limit fraud)—you have to be accredited, you have to have criminal background checks, you have to be fingerprinted, you have to obtain a surety bond. You had to have all these things, and they've been lifted during the public health emergency. Anyone can get into the program as a supplier right now. That worries me. It doesn't worry me that a bunch of people who have been in business for a long time are going to start billing like crazy; but it worries me that people coming in from the outside will.

HME: Have you heard that CMS has seen a spike in enrollment during the emergency?
van Halem: I don't have the answer to that, but I would love to know. CMS did say that they would be watching the claims submitted by these new companies closely and that once the PHE is lifted, they would have to meet all the requirements within 30 days. But if you're a criminal all you need is a short period of time to submit a bunch of claims and take off.

HME: Did the special agents say where they were focusing their investigative efforts?

van Halem: They're definitely focused on phone solicitation. I'm working from home today and I got a call for my mother from a company saying she was able to get diabetic supplies and a CGM machine. I asked where they were calling from and it was a DME company from New Jersey. I'll certainly be reporting that.

HME: What are you advising your HME clients to be doing during this unprecedented climate of relaxed requirements?

van Halem: If you can get the documentation you normally would, we recommend still doing that. With refills, for example, you can still call the patient and ask them if they need it. It concerns me that the good folks who are just training to maintain their patients right now will also have their claims scrutinized later and will get caught up in these audits.