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Robert Church

United states, United States

SME-Healthcare Fraud, False Claims Act, Antikickback, Financial Forensics/Accounting, Tax Crimes.

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COVID19 31.40
Health and Safety 30.56
Health and Wellness 30.15

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3 Article/Blogs
Fraud and Abuse in Federal and State Healthcare Programs - Much More Than Money
April 02, 2021
Current estimates place percentages on healthcare fraud and abuse at between 3% and 10% of every claim submitted, which translates to an approximate value of just over $300 Billion annually. Certainly, this has a crippling economic effect on healthcare programs and delivery systems, obviously affecting operations and opportunities to provide leading-edge care.

These numbers are supported by Health and Human Services/Office of the Inspector General (“HHS/OIG”) as well as the National Health Care Anti-Fraud Association (“NHCAA”) and while the exact numbers elude calculation and reporting, the estimates are staggering in and of themselves!

Lauren Hersch Nicholas, assistant professor at Johns Hopkins Bloomberg School of Public Health and a widely respected author reports that healthcare fraud and abuse resulted in approximately 7,000 deaths in 2013 alone, all of which were deemed “premature”. This further exemplifiesJohns Hopkins’ statistics which reflect that patients who received healthcare services by providers later excluded/debarred from participating in federal and/or state healthcare programs (for healthcare frauds and/or abuses) were between 14% and 17% more likely to die than those who received healthcare services by providers who followed the rules.

The populations who are most affected by federal and state healthcare programs are those enrolled in Medicare (typically those over age 65) and Medicaid (aged, blind, disabled, children, long-term care residents, and others, many of whom are without other means to access healthcare. Federal and state healthcare programs are fraught with bad actors committing fraud and abuse. The fact that these populations are disproportionately targeted provides a logical connection that they are the ones who will suffer most from nefarious actors and their schemes to game the systems.

The almost 7,000 documented deaths, discussed by Ms. Hersch Nicholas, are beyond troubling and suggest that efforts by States and the federal government be redoubled to curb fraud and abuse schemes, large and small. Sadly, the connection between improving one’s financial status by taking advantage of those who need the most and often the best care, demonstrates the premise that healthcare fraud and abuse is much more than a simple financial, “no-one-gets-hurt” crime.

See blog

Tags: Health and Safety, Health and Wellness

COVID-19 Fraud: Schemes Being Perpetrated and Their True Costs to the United States
February 24, 2021
Since the advent of COVID-19, criminals across the globe have been exploiting the virus via a multitude of fraud schemes. This has come to the attention of the FBI and other federal law enforcement agencies, including HHS/OIG.

Sadly, this fraud is so rampant that a recent report found that over $175,000,000 has already been scammed out of innocent, trusting people who have fallen for these schemes out of fear, intimidation, news reports, promises of cures, and the overwhelming number of robocalls that make false promises.

These schemes have become extremelyconvincing, and include fraudulent promises of antibody tests. In these schemes, callers and advertisers want your personal and health information so that they can bill for false tests and either get paid by the insurance companies or by individuals without health insurance.

Examples of Fraud Schemes

One example to be aware of is the fact that no antibody test has been approved by the Food and Drug Administration. Any claim to the contrary is false, and a potentially fraudulent way to obtain your health information.

Another includes antibody tests that are promoted via social media platforms like Facebook, Instagram, and LinkedIn. These types of promotions may also come through telephone calls, emails, texts and various other online advertisements as well.

Those who market COVID-19 tests and promise great free benefits if you provide your health insurance information are purely marketers looking for your personal data, which you should never provide.

If anyone who says they are from the federal or state governments contacts you, and mandates that you must take the antibody test, do not listen to them and do not give them any information. These calls are also fraudulent.

Finally, any medical practitioner (e.g. doctor, nurse practitioner, nursing assistant, RN, or lab professional) who will only take cash in exchange for the testing is acting in a fraudulent manner.

Additional Examples of Fraud

At this juncture, there is no cure for COVID-19, despite vaccines having recently been approved by the FDA. Beware of sales calls, emails, online ads, and social media ads promising cures. These claims are false, and all the person on the other end cares about is taking your money.

If you receive calls from the IRS or Department of the Treasury Department, always remember that the IRS never calls. They use USPS first.

Also, anyone promising stimulus checks is a fraudster.

If you are receiving mass mailings about COVID-19, they too are false and only want your personal health information (PHI). Never share this information with anyone other than your healthcare provider.

Never give out your Medicaid or Medicare card information either; they will only use it to bill those payors, without a service ever being rendered.

Never buy a STEAM, ITUNES, GOOGLE Play, money order, or Money Gram card or send cash to strangers who request it. The overwhelming majority (approximately 99%) of such requests are fraudulent.

Never share your banking information with people who call, email, send you direct mail, or sellon social media platforms. Once again, they only want your money.

Protect Your Personal Information

All these fraudsters want is your personal information, your healthcare information,your healthcare card information and/or any other personal data. The key is to be aware of all of these schemes, and to make sure your information doesn’t fall into the hands of strangers with mal intent. This will ensure that you are not scammed out of significant monies.

As a nation, we have to be diligent, aware and on guard to protect ourselves, as well as our money and personal data, including health data. This is a time to be prepared and to listen to what the government publishes; if it comes from anywhere else, beware.

See blog

Tags: COVID19

The 10 Most Common Fraud Schemes That Have Arose from COVID-19
February 24, 2021
Unfortunately, natural disasters represent a prime time for fraudsters to strike – with their multitude of schemes and scams – and during the period when people are likely most vulnerable. During these times, most people aren’t thinking about fraud. Government agencies aren’t either. Their primary focus is onhelping people, as opposed to stopping fraudsters from fleecing unsuspecting people who are grasping for their belongings, their homes, and their safety.

The federal government has projected that COVID-19 fraud has the potential to be the most significant fraud in the United States. This is due to the length of time the pandemic has plagued the country, as well as the non-stop flurry of accurate, inaccurate and politically motivated news about its dangers and the damaging effects it has had on the economy as a whole. People are scared of the virus and want the best to either prevent it, deter it, and/or recover from it should they contract it. This presents fraudsters with the opportunity to act in ways which benefit them – and subject citizens to having their monies taken.

The fraud schemes during this COVID-19 environment include, but are certainly not limited to:

  1. Phishing and malware schemes. Malicious software and fraudulent communications meant to gain data, damage devices, and induce people to provide financial data, credentials, and log-in information.

  2. Spoofing schemes. Those which are designed to appear as being generated from legitimate sources but, in fact, are criminal in nature.

  3. Fake COVID-19 apps. These can be used to infiltrate individuals’ information and then demand a “ransom” to be paid in bitcoins, or else all personal information will be released on the Internet.

  4. Product scams. These include products which do nothing to contain, deter, prevent or cure the virus; but are, instead, fake products, unsafe products, damaged goods, or even counterfeit goods (e.g. personal protection equipment, hand sanitizer, masks, latex gloves, cures for the virus).

  5. Medical supply scams. Similar to product scams but include ventilators, masks, gowns, related medical supplies and hospital-associated supplies.

  6. Business email fraud. Fraudsters attempting to gain employee data (e.g. social security numbers, addresses, full names, phone numbers and other identifiable data) which can be sold or used to garner payments and compromise or misdirect transfers of monies.

  7. Investment fraud. The pumping and dumping of penny stocks for companies that have “found the cure” for the coronavirus. With these types of scams, there are promises of great returns on investments in gold, silver, and other precious metals and cryptocurrencies.

  8. Charity scams designed to make people believe they are legitimate, and that the donations will be used for the stated purpose. In reality, they are nothing more than shell companies designed to take your money.

  9. Testing scams designed to report positive tests, as well as sell fake or counterfeit goods,to raise revenue from the billing to insurance companies.

  10. Cures for the virus. These are being sold as fast as people can make them up.The most recent was a cure using Clorox, which was touted and sold on Amazon as the greatest cure ever.

To date, COVID-19 fraud has cost Americans approximately $200,000,000, while over $30B in stimulus funds have been distributed. These numbers are reported by the FTC and the U.S. Secret Service. Unfortunately, there is no end in sight, and projections reflect no meaningful change for at least another 12 months.

See blog

Tags: COVID19


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