With medical providers beginning to bill Medicare and other government funded health care programs for COVID-19 tests, instances of fraud may soon emerge.
At the beginning of February, new CPT codes were promulgated to cover COVID-19 tests. However, providers who bill under these new codes along with other lab codes may be engaging in Medicare fraud for submitting claims that were not medically necessary.
For example, a provider billing for both a COVID-19 test and a Respiratory Pathogen Panel (RPP) has likely submitted claims for procedures that are not medically necessary. The RPP is a test for multiple viral and bacterial infections. Billing for both a COVID test and a RPP to rule out other cases of symptoms is not medically necessary, as it is likely duplicative.
Health care fraud like this can be combatted by whistleblowers under the False Claims Act (FCA). The FCA allows those who uncover fraud against the government to file a civil action on behalf of the government and share in any recovery. In the health care fraud arena, the FCA would apply to fraud against any government funded program, including Medicare, Medicaid, Tricare, the VA, or federal employee health care programs. While the FCA applies to fraud against the federal government, many states have similar laws that can be used if state funds have been abused.