Balancing the delivery of necessary healthcare services with the needed fraud, waste, and abuse controls is vital for the healthcare system to be resilient to the impact of the COVID-19 pandemic, as well as future national emergencies.
Since early 2020, coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has significantly shaped public life and healthcare delivery across the country. The impactful nature of the virus led to necessary comprehensive changes in the nation's healthcare system. As a result of these changes, potential vulnerabilities have been identified that enabled bad actors to adapt previously existing healthcare fraud, waste, and abuse schemes. In response, the Healthcare Fraud Prevention Partnership (HFPP), detailed below, has released its latest white paper titled, "Fraud, Waste, and Abuse in the Context of COVID-19".
The HFPP is a voluntary public-private partnership whose members work to identify and prevent fraud, waste, and abuse across the healthcare sector. HFPP Partners include federal government, state agencies, law enforcement, private health insurance plans, and health care anti-fraud associations. These HFPP Partners represent approximately 75% of covered lives in the United States. The ultimate goal of the HFPP is to stop waste, fraud, and abuse before they even start—and before healthcare dollars are lost or stolen.
The goal for this white paper, developed with direct input from HFPP Partners and in collaboration with researchers from Stanford University's School of Medicine, is to first provide a foundational background on COVID-19, efforts to test for and treat the virus, and the changes to practices and policies implemented to improve the delivery of healthcare during the Public Health Emergency (PHE). The paper then highlights trending fraud schemes including billing for potentially unnecessary services, incorrect coding and billing, and direct solicitation and identify theft. Finally, the white paper offers strategies and actions for healthcare payers to consider and apply. Described methods include:
Increasing collaboration with stakeholders and using focused data analytics to speed and bolster detection efforts
Taking and supporting enforcement actions through increased communication with and amongst law enforcement about identified vulnerabilities
Educating providers about policy changes and members, beneficiaries, and patients on best practices to prevent fraud, waste, and abuse
Broadly, this white paper outlines important steps that federal and state agencies, private payers, and law enforcement have taken in identifying and responding to fraud, waste, and abuse related to the delivery of care for COVID-19. These actions and lessons learned may allow these parties to anticipate vulnerabilities moving forward, providing a foundation for navigating a changed healthcare landscape and future challenges.
For additional information, please see:
Fraud, Waste, and Abuse in the Context of COVID-19 White Paper
Fraud, Waste, and Abuse in the Context of COVID-19 White Paper Information Sheet
About the HFPP
The HFPP is a voluntary, public-private partnership comprised of 235 Partner organizations from the federal government, state agencies, law enforcement, private health insurance plans, employer organizations, and healthcare anti-fraud associations. Our goal is to identify and reduce fraud, waste, and abuse across the healthcare sector through collaboration, data and information sharing, and cross-payer research studies. Given the HFPP's broad membership encompassing a variety of stakeholders involved in the detection of fraud, waste, and abuse in the healthcare system, it is uniquely positioned to examine emerging trends and develop key recommendations and strategies to address them.