May 15, 2020
COVID-19 Fraud Prevention

Applicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care, Mercy Mercy DD and Mercy Care Advantage

It's unfortunate that Mercy Care, our provider network and our members have to deal with fraud schemes, especially in these trying COVID-19 times. Fraud schemes related to COVID-19 play on public fear and may allow scammers to access personal, insurance, debit and credit card information, unless we are all vigilant and alert to these schemes. We would like to alert you to methodologies scammers are using to get this information:

  • Contact Methods: Individuals are being contacted through phone calls, phishing e-mails, social media, websites and door-to-door visits.
  • Unsolicited Offers: These offers may come through as COVID-19 testing, sales of unauthorized test kits, counterfeit treatments, protective equipment and DME supplies in exchange for personal information.  
  • Phishing E-Mails: Scammers may try to solicit personal information by claiming to provide help to receive stimulus funds, general financial relief, or posing as charitable organizations.
  • Marketers: Marketers may target Nursing Homes, Assisted Living Centers, Churches and Synagogues claiming to be representatives from an insurance company or government agency in an attempt to collect an individual’s Medicare and Medicaid information.
  • Healthcare Providers: Providers are being targeted via social media, Craig’s List, etc. for telemarketing scams. Providers are being offered jobs for telehealth and COVID-19 testing with these offers being rescinded after a provider has shared their Medicare/Medicaid enrollment billing information.  
  • Telemarketing Companies: Illegal kickback activities with international calls centers, health care professionals and DME companies to submit fraudulent claims. 
  • Laboratories: Test claims that may involve fraudulent billing/bundling.
  • Drug Telemarketing: Schemes may involve billing for medication(s) an individual has not been appropriately evaluated to take.  
  • Virus Protection: Schemes that claim the medications promoted will protect against the virus or promises to provide COVID-19 testing if an individual agrees to receive the medications.
  • Topical Drugs, Nasal Rinse/Mouthwashes: Promotion of expensive antibiotics, antifungals, as well as steroids.

As a result of the coverage policy flexibilities and waivers implemented by CMS and AHCCCS in support of COVID-19, it has opened the door for more fraud, waste and abuse activity. As treatment for COVID-19 evolves, the schemes and methods used by scammers will evolve to continue to exploit the system.

It's important for everyone be alert, vigilant and monitor for fraud, waste and abuse activity involving our Mercy Care and Mercy Care Advantage plans. Please report suspected Fraud, Waste, and Abuse activity immediately by contacting the Mercy Care Fraud Hotline at: 800‑810‑6544. All suspected incidents are investigated by the applicable internal parties and reported timely to both CMS and AHCCCS.

As always, don't hesitate to contact your  Mercy Care Network Management Representative  with any questions or comments. You can find this notice and all other provider notices on our  Mercy Care   website.
Thanks for your attention to this important matter. It's important to all of us to keep our information private and safe!