Skip to Main Content

From the Gateway Health, LLC (“Gateway”) Payment Integrity Team: Look Out for COVID-19 Fraud Attempts

May 13, 2020
|
News | From the Gateway Health, LLC (“Gateway”) Payment Integrity Team: Look Out for COVID-19 Fraud Attempts

The Gateway Payment Integrity team is dedicated to protecting our members, providers, and the healthcare system from fraud, waste and abuse. Fraudsters are using these challenging times to take advantage of unsuspecting providers and members.

Fraudsters are incorrectly billing healthcare programs for fraudulent or wasteful services, which can increase medical costs and put an unnecessary strain on the entire healthcare system.

Gateway encourages all stakeholders to remain on high-alert for any suspicious activity, including the following examples provided by law enforcement:

  • Advertisements or offers for vaccinations, medications or testing that are not recommended by the Centers for Disease Control and Prevention (“CDC”), a local health department or a health care provider. Fraudsters may offer these items in exchange for Medicare or Medicaid numbers or other personal information.
  • Phishing attempts related to COVID-19 from individuals pretending to be providers or healthcare organizations attempting to steal personal information or install malware on your device. Fraudsters may reach out via email, by telephone or on social media.
  • Advertisements for products that are ineffective in treating COVID-19 and its associated symptoms. Examples may include supplements, oils, ointments or herbal treatments.
  • Advertisements and offers for personal protective equipment (such as face masks) where the order is never fulfilled or defective or expired products are delivered to providers, members or employees.
  • Beware of people coming door-to-door offering to do in-home examinations or testing for COVID-19. Any examinations or test should be completed by your health care provider.

If you see something, say something – reporting options

If you have experience with any of the above, we want to know! You can report suspected fraud, waste or abuse to Gateway’s Payment Integrity team through one of the following means:

  • Call our Fraud Hotline at 412-255-4340 or 1-800-685-5235 (TTY Users can call 711 or 1-800-654-5984).
  • Submit an online referral on Gateway’s Fraud and Abuse website.

Remember, you can choose to make an anonymous report. Thank you for your support.

For additional resources, go to: https://www.gatewayhealthplan.com/coronavirus