Recently announced Department of Justice (DOJ) priorities include a reinvigoration of health care fraud prosecutions. The COVID-19 crisis created fertile ground for not only fraud related to the Paycheck Protection Program (PPP) but recent announcements make crystal clear that enforcement of health care fraud arising from COVID-19 related schemes also has a high priority.
With billions in government funds at stake, only the human imagination limited potential fraud possibilities. The DOJ has formed the COVID-19 Interagency Working Group as part of the Health Care Fraud Unit. Individual executives and business entities were targeted for criminal prosecution for violations relating to telehealth billings, COVID-19 testing, improper test bundling, and overbilling, among other COVID-19 related schemes. Like PPP fraud allegations, many of the health care fraud allegations relate to attempts to take advantage of limited government oversight given the massive sums of money and relative speed of the new funding.
While the prosecution of civil and criminal health care fraud violations is not new, the COVID-19 crisis exponentially increased the fraud exposure. Health care providers and contractors should pay particular attention to COVID-19 related billings and procedures to ensure compliance. Self-audits and compliance checks are just two actions that can be taken to minimize the risks of liability.
Examples of some precautionary steps which could prevent fraud include:
- Create or review internal controls, such as spot audits on billings to Medicare, to assure proper coding and medical need.
- Implement and enforce internal policies and procedures so that all team members know what is required and what the penalties are for improper conduct.
- Perform due diligence background checks of contractors hired to support billing or testing. For example, checking whether or not an entity has been excluded from federal health care programs is easily done as the U.S. Department of Health and Human Resources provides online searchable databases to identify those who have been excluded.
- Careful supervision of any bundling of COVID-19 testing with other testing.
- Be alert for use of “emergency override” billing to avoid pre-authorization requirements.