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By Wayne van Halem, AHFI, CFE, President of The van Halem Group

As an Accredited Healthcare Fraud Investigator and Certified Fraud Examiner, I must attend courses to obtain CEUs to maintain my accreditation and certification. I attended one last week hosted by the National Healthcare Anti-fraud Association, a group of which I am an active member and have served on its faculty. The webinar was regarding COVID-19 Fraud.

In the webinar, Special Agents from the Office of Inspector General (OIG) Office of Investigations (OI) shared information regarding fraudulent scams and schemes that they are already seeing related to the COVID-19 pandemic. If that is not disheartening enough, the first example that the agents presented was involving suppliers of DMEPOS items and services.  Something we were all afraid might happen. 

In the DMEPOS fraud example, the agents indicated that Medicare beneficiaries are receiving unsolicited phone calls indicating that they are required to have a COVID-19 test as ordered by the Trump administration. The caller then asks for their Medicare number, and unfortunately, some do trustingly provide this information. Once they have this information, they close the call.  Two weeks later, the beneficiaries received items of durable medical equipment that were not ordered or needed.

I asked the agents what type of medical equipment, curious if the equipment was respiratory in nature and the response, perhaps not surprisingly, is that it is related mostly to orthotic braces, once again. However, they did state that they have seen other types of equipment as well, including diabetic test strips.

This is bad news. Last week, I penned a letter to the industry about building trust and promoting value during the unique opportunity being presented to us. I expressed my concern over the flexibilities and waivers that CMS has implemented, including waiving all background checks, accreditation requirements, and fees associated with enrolling as a DMEPOS supplier. This action alone has made our industry and the Medicare Trust Fund extremely vulnerable to these unscrupulous suppliers that make things very difficult for all those just trying to take care of their patients during this complex and challenging time.

I’m concerned of the impact this might have on the industry as a whole. I hope federal agencies are able to swiftly and strongly take action against these individuals committing these fraud activities. And even more so, I hope CMS understands that these individuals are not a reflection of our industry. 

As a reminder, it is important for our industry to police itself. That is why VGM is reminding everyone that if you are aware of individuals or entities that are committing fraud or abuse, you can alert the Fraud Eradication Advisory Team (FEAT) who will provide information to the appropriate authorities. The HME industry provides value beyond measure to its patients. Let’s work together to eliminate fraud and show our value to CMS.