Vice President JD Vance spoke to Wisconsin citizens recently about fraud and efforts to stop it. His lead example was about how fraudsters have set up companies, quickly billed for oxygen concentrators, hospital beds and alike, but never delivered a thing. Rather their modis operandi was to ‘bill, collect and close’, and then create another company to do the same thing. This is a truth about fraud in government health care companies; there are real companies like SurfMed but there are also fake companies that abuse the system for personal gain.
Being a 69-year-old company, SurfMed has seen other companies, and their owners, do this and similar fraud, for generations. SurfMed has been a leader in bringing these issues to state and government officials and has worked with regulators to improve protocols and policies to prevent fraud because SurfMed knows that fraud in our industry will reflect poorly on all of the industry.
Aside from the large fake fraudsters, there are smaller actions taken by many which fall into the category of fraud and abuse due to competitiveness, cheating or just a lack of knowledge, but no matter the reason, it needs to stop. Some providers call members in advance of entering a Medicaid Managed Care program and solicit members to use their services. This is against the law. A classic South Florida fraudulent act is the giving gift cards, purses, and high end shoes, or throwing huge parties for Case Managers with lavish gifts, to assure that Case Managers influence members to choose a specific company. This is outright fraud, but no one was looking, so many participated. Now though the federal government is demanding that states and MCOs look into all circumstances and by using data analytics and real investigation, they are identifying those who perform criminal acts and are stopping them. Case Managers’ actions are being looked at because participation in these activities is a two-way street, so all must be aware and follow the law.
If you see fraud, if you are solicited to give our Medicaid numbers, if a member tells you they were inappropriate contracted, report those instances immediately. Everything is not fraud, but it is better to be safe than sorry and to act to support the anti-fraud efforts.
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