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Medical Group Management Association

Shifts in federal focus on healthcare fraud during the COVID-19 pandemic

Insight Article - September 22, 2021

Medicare Payment Policies

Compliance Regulations

Federal Compliance

A public health emergency is a ripe opportunity for potential fraud schemes in the healthcare industry, and the evolving threat is continually being assessed and combated by the federal government.

In an Aug. 31 MGMA webinar, “Protect Your Practice: Healthcare Fraud and the Federal Perspective,” Kathleen McGinty, JD, deputy director of the Investigations & Fraud Prevention Partnerships Group (IFPPG) of the Centers for Medicare & Medicaid Services’ (CMS) Center for Program Integrity (CPI), noted that fraud schemes targeting medical practices and federal programs have changed during the COVID-19 pandemic.

The CPI’s mission focuses on protecting the resources for national healthcare programs, as well as the health and well-being of beneficiaries of CMS programs. “Never has this mission been more important than during the COVID-19 public health emergency, where we saw rapidly rising fraud schemes that directly impacted the health and well-being of our beneficiaries, as well as the public at large,” McGinty said.

McGinty, who spent time as a critical care nurse in addition to working in healthcare fraud investigations, said it’s been important to understand the impact that fraud investigations can have on providers in such a stressful time. McGinty called it a “delicate balance” of trying to avoid overburdening healthcare providers with records requests and investigations during the public health emergency (PHE) yet still addressing emerging fraud schemes. “We did see bad actors exploit some of our waivers that we put in place.”

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