COVID-19 and health care fraud

Colleagues Melissa Garrido and Michael Adelberg have published a piece on the Health Affairs blog about health care fraud pertaining to COVID-19.

The COVID-19 epidemic has placed enormous stresses throughout the health care system. Congress, through the CARES Act, seeks to address these needs with additional money in the form of loans, grants, and increased Medicare and Medicaid funding. Meanwhile, the Trump administration has relaxed numerous rules and regulatory processes to increase the health care system’s capacity and to allow providers to focus on patient care during a national emergency. […]

There are compelling health policy arguments for relaxing regulatory processes and requirements during a national emergency; strong action is necessary to address the COVID-19 crisis. Yet while leaders across the federal agencies are focused on consumer-facing COVID-19 scams, there is not yet corresponding concern on payer-facing fraud and waste. Preventing fraud and waste is more efficient than recovering improper payments. Affirmative statements from agency leaders that the federal government is watching might deter some bad actors. After the surge of COVID-19 infections pass, CMS and state Medicaid programs should conduct outlier analyses to identify areas where fraud and waste probably occurred; targeted auditing and investigation will be warranted.

Research for their piece was supported by the Laura and John Arnold Foundation. Go read the whole thing.


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