Navigating lead generation safely

ATLANTA - Wayne van Halem gets contacted “all the time” by companies that are having issues with audits. A common factor? Lead-generating companies, he says.

These are companies that are new to the industry and those that are well established, he says.

“They will convince people that they can make them a lot of money,” said van Halem, president of The van Halem Group. “They get told, ‘We’ll do all the work and the paperwork, and all you have to do is submit the claim.’”

That’s not to say all lead-generating companies are bad, says van Halem. But with new contracts for off-the-shelf back and knee braces set to take effect Jan. 1, it’s important for companies to separate the good from the bad, he says.

Read the fine print

Providers considering a lead-generation arrangement must do their due diligence, including reading all contracts, and verifying all their processes and procedures, says van Halem.

“Understand how they develop their leads, look at their marketing material, understand the whole process,” he said. “The way you pay for leads generated by Medicare differs than commercial plans. You can’t pay per lead, for example.”

It’s a good idea, in general, to have an independent attorney review everything, says van Halem.

Know where they’re based

Numerous lead-generating companies are overseas now, says van Halem.

“That’s not necessarily bad,” he said. “Make sure they are legit, and they understand the rules in our country.”

Be aware

Operation Brace Yourself, in which the federal government in 2019 took down a $1.2 billion scheme involving illegal kickbacks and bribes by DME companies in exchange for referrals of Medicare beneficiaries, has increased awareness of the potential landmines of contracting with lead-generating firms, van Halem says.

“My concern is some companies that have never done braces may not have been paying as much attention,” he said. “These companies are relentless.”

The latest scheme: COVID, says van Halem.

“Companies are calling Medicare beneficiaries and telling them President Trump has ordered all beneficiaries to be tested for COVID,” he said. “Two weeks later, braces showed up.”