Healthcare Fraud for Nurse Practitioners

In September 2019, The Department of Health and Human Services Office of the Inspector General and law enforcement announced they were able to take down 35 individuals for participation in healthcare fraud schemes involving $2.1 Billion in losses.

We’ve almost come to expect news like this.

In the above example, OIG was targeting genetic testing fraud schemes. They are taking place nationwide.

What happens with these is that a recruiter (aka marketer) gets a provider to sign off on the genetic test so the test can be processed by the lab. The recruiter pays the provider a kickback. The lab…it bills MCR and is reimbursed, and it shares it proceeds with the recruiter.

Chances are that you have already seen advertisements to consumers regarding these genetic testing. They might be advertised as

  • Cancer screening and tests
  • Hereditary cancer screening/test
  • Pharmacogenetics (medication metabolization)
  • DNA Screening test
  • Dementia Screening Test
  • Parkinson’s screening/test

Consumers will often be told that the test is free or at no cost to them, and they don’t need a physician’s order, simply make an appointment on this telemedicine platform to arrange for testing.

It will often be the physician or the NP on that platform giving the okay for the test. The provider may or may not be suspicious about the company and the tests.

This past week, during the NPBO™ Office hours, I was speaking with a seasoned NP who had been approached about this. The company involved would send MAs to the homes of patients and obtain these test. They were then asking this NP to sign off on the orders and do some documentation.

Fortunately, this NPs early warning system (aka – her gut) was in fine working order and she questions medical indications, who saw the patients etc…and most importantly did not sign anything, and was planning on severing her relationship with this company.

In this episode of the NP Business Matters podcast, I discuss further examples of fraud, talk about Anti-Kickback and Stark laws, what we can do if we spot it and how to protect ourselves and our practices.

Fraud Resources

More Resources

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