While the pandemic brought out the best in many people – including people who delivered food to elderly neighbors, sewed masks, and risked their lives to care for afflicted patients, it also created opportunities for offenders.
Fraudsters quickly took advantage of the health crisis. They adapted their practices to establish methods to target the public, predominantly through cyber-enabled means, online, text message, and social media, always using covid-19 as a hook to target and con vulnerable and older people from their savings. National Money Laundering Risk Assessment (NMLRA) in 2018 found that healthcare fraud was the largest source of unlawful funds in the U.S, with over $110 billion in proceeds generated each year.
Criminals are using the entire entourage of scam tools – phishing emails, bogus social posts, robocalls, imposter schemes, texts, and more – and closely following headlines, adapting their techniques and tactics as new medical and economic issues arise. Fake reporting intended to fraud publicly funded health care is widespread and growing. It reflects the size of the healthcare system, the lack of oversight and communication in the reimbursement process, and the tremendous amount of money involved. All of these things make public health care an irresistible target.
How does healthcare fraud work?
As reviewed by healthcare experts at Health 2.0 Conference, corporate fraud by healthcare providers accounts for a significant share of the scam. Many fraud schemes mimic genuine transactions with complicit doctors and other medical professionals. Additionally, the enormous size of healthcare claims makes fraud detection a challenge. Healthcare fraud can be committed by medical suppliers, patients, and others who intentionally mislead the healthcare system to gain unlawful benefits or payments.
Public healthcare fraud involves false representations of medical conditions made to healthcare providers or the government. Sometimes this includes fabricating reports relating to patient disease, addiction, accidents, or crime, and sometimes it means fabricating reports to conceal patient neglect and abuse.
Common types of fraud by dishonest providers
- By using legitimate patient information, sometimes obtained through identity theft, to entirely bogus claims or by paddling otherwise claims with charges for procedures or services that did not take place.
- Billing for more high-price services or procedures than the performed services, i.e., falsely billing for a higher-priced service.
- By performing unnecessary medical services or misrepresenting non-covered treatments as medically necessary, their aim is only to generate insurance payments. It is probably the most common way of defrauding the government. Upcoding involves services that no one has performed or services that one has performed but with inferior quality. As reviewed by health luminaries at the Health 2.0 conference, they charge for the premium services in the name of cheaper, inferior services.
- Kickback schemes are rampant in the healthcare industry. In general, it is unlawful for any doctor or medical facility to receive anything of value from another doctor, healthcare facility, pharmaceutical company, medical device manufacturer, or any else to meet certain criteria to prescribe a specific medication. It is unethical to make any conclusion that could be corrupted by the offering rather than arrive at it based on experience and the client’s best interest.
- A growing trend, however, is to allow nurses and office staff to handle routine outpatient procedures while billing the government for the cost of the doctor’s time to perform the work. It is unlawful and could pose real threats to the patient if an untrained staff performs a complex medical procedure.
- Dishonest providers take unethical routes by exploiting vaccine mandates in some workplaces. Health experts at Health 2.0 Conference suggest that scammers send mail purporting to be from human source departments, requesting workers’ proof of vaccination. Links in the direct message target a fake sign-in page where the scammers can harvest log-in details.
- Sending out emails and text messages camouflaged as surveys about covid 19 vaccines, they promise to provide a free reward if you provide bank or credit card details to cover a small fee.
Tips to avoid COVID-19 scams
- Refrain from clicking links or downloading files from unknown sources, even if the sender seems to be a business, government body, or person you recognize.
- Do not share your details, such as credit card numbers, in response to unsolicited calls, texts, or emails.
- Do not respond to unsolicited calls, emails, or text messages offering rapid tests and other products related to COVID-19. Always check for the approved websites and testing companies that are providing online tests.
- Talk to the doctor or seek advice from your local health department to find genuine testing sites. Even if you are attending a clinic, keep an eye on workers. If they could not answer questions about the testing process, these should be a red flag for you.
- Ignore offers that are giving vaccination certificates for a small fee. They are scams. We can only obtain a valid proof of vaccination from legitimate vaccine providers.
- Look out for fake calls, emails, or text messages urging you to invest in new surging stock from an organization working on coronavirus-related products or services.
- Be wary of fundraising emails for COVID-19 victims or virus research, especially if they pressure you to act quickly and request payment by prepaid debit or credit cards.
- Call your insurance company immediately if you doubt you may be a victim of a health insurance scam. Most insurers have the resources to report online scams through their websites.
- Additionally, healthcare experts from Health 2.0 Conference suggested that you be informed about the healthcare service you receive, take good care of your medical record, and closely observe and review all medical bills you receive.
One of the principal lessons you can learn is that there will always be a scam in an emergency. It has already been demonstrated worldwide by other disasters in the past. Most healthcare providers have high integrity, and many have risked their lives and health to care for others. Still, history suggests that bad actors take advantage of the situation. To learn more about the growing scams in the healthcare sector and ways to combat them in the future, you can join us at our Health 2.0 Conference this winter.