TELE-MEDICINE Fraud, Abuse and New Barriers!

Telemedicine: Fraud and Abuse During the COVID Pandemic

By Susan Walberg

The COVID-19 pandemic has brought with it huge challenges for people all over the world; not only the obvious health-related concerns but also shutdowns, unemployment, financial difficulties, and a variety of lifestyle changes as a result.

When the COVID pandemic struck, CMS quickly recognized that access to care would be an issue, with healthcare resources strained and many providers or suppliers shutting down their offices or drastically limiting availability. Patients who needed routine care or follow-up visits were at risk for not receiving services during a time when healthcare providers were scrambling to enhance infection control measures and implement other new safety standards to protect patients and healthcare workers.

The Centers for Medicare and Medicaid Services (CMS) has responded by easing restrictions and regulatory burdens in order to allow patients to receive the healthcare services they need without undue access challenges. One key area that has changed is the restrictions related to telehealth services, which were previously only paid by Medicare under certain circumstances, such as patients living in remote areas.

Among the changes and waivers CMS has offered, telemedicine reimbursement is among the more significant. Telemedicine services, which includes office visits and ‘check ins’ are now allowed and reimbursed by Medicare. In addition to reimbursement changes, CMS has also relaxed the HIPAA privacy and information security enforcement standards, paving the way for providers to adopt a new model of providing services electronically.


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What Exactly is a PONZI SCHEME; etc?


By Dr. David E. Marcinko MBA CMP®

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A Ponzi scheme (/ˈpɒnzi/, Italian: [ˈpontsi]) is a form of fraud that lures investors and pays profits to earlier investors with funds from more recent investors. Recall Bernie Madoff.


The scheme leads victims to believe that profits are coming from legitimate business activity (e.g., product sales or successful investments), and they remain unaware that other investors are the source of funds. A Ponzi scheme can maintain the illusion of a sustainable business as long as new investors contribute new funds, and as long as most of the investors do not demand full repayment and still believe in the non-existent assets they are purported to own.


A pyramid scheme is a business model that recruits members via a promise of payments or services for enrolling others into the scheme, rather than supplying investments or sale of products. As recruiting multiplies, recruiting becomes quickly impossible, and most members are unable to profit; as such, pyramid schemes are unsustainable and often illegal.



How to Spot and Protect Yourself From Investment Fraud

Pyramid schemes have existed for at least a century in different guises. Some multi-level marketing plans have been classified as pyramid schemes.

And, there are MANY other schemes in the financial services sector.


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IRS Cracking Down on Tax Identity Fraud

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About Stolen Identity Refund Fraud [SIRF]

[By Children’s Home Society of Florida Foundation]

The IRS, the Justice Department and Congress all recognize that stolen identity refund fraud (SIRF) is a major and growing problem. With the increase in electronic filing, individuals are obtaining the Social Security numbers and names of other persons and filing to claim their tax refunds. The Justice Department estimates that there could be up to $26 billion in fraudulent refunds over the next five years.

Assistant Attorney General Kathryn Keneally of the Tax Division of the Justice Department conducted a briefing on September 27 in Washington. She acknowledged, “The stolen identity refund fraud cases present a different kind of crime than we usually see.” Keneally continued and explained the depth of the problem. Treasury officials understand that greater efforts are needed by the IRS, Department of Justice and U.S. Attorney’s Office to confront the problem.

How Identity Thieves Work

How do most identity thieves operate? The essential information for an identity thief is a name and a Social Security number. There are at least three ways that identity thieves are collecting this information and receiving tax refunds.

  1. First, some have persuaded a postal employee to intercept multiple refunds to an address.
  2. A second strategy might involve the use of a doorman to direct refund checks to the identity thief.
  3. Third, bank tellers have been bribed to collect the personal information necessary for the identity thief to file and obtain a fraudulent refund.

Geographic Dispersion

Two areas of the country are particularly affected. Southern District of Florida U.S. Attorney Wilfredo Ferrer acknowledged the problem there. He stated, “This is the fastest growing and most insidious fraud in this district right now. It’s sort of like the crime du jour.” He is regularly finding victims “from all walks of life” who had their identities stolen so the thief could collect a “bogus tax refund.” Ferrer disclosed that there are even victims who work in the office of the U.S. Attorney.

Another area with a significant problem is the Southern District of New York. Deputy U.S. Attorney Richard Zabel pointed out that many New York thieves are involved in tax fraud. He stated, “It’s like Willy Sutton – Why do you rob banks? Because … that’s where the money is!

Well, if you’re doing identity theft, the big money is in the Federal Government’s bank account.”

e-Filing Challenges

The IRS recognizes the challenge with eFiling. On the one hand, the IRS has greatly improved the speed of refunds for lawful taxpayers who eFile. In addition, the eFiling of tens of millions of tax returns saves a huge amount of time and cost for the government in processing tax returns.

However, the challenge with eFiling is that the thieves are able to obtain information and file before the legitimate taxpayer. By the time the actual taxpayer files, the thief has received the refund. In some cases, thieves have promptly transferred the funds outside of the United States.

Large Scale Networks

Some thieves are operating on a fairly large scale. Attorney Zabel referred to one case in New York in 2009. Two individuals filed 7,000 false returns and requested a total of $72 million in refunds. Because the refunds were sent to the same address, the fraud was discovered.

Congressional Legislation

Congress has several bills under consideration that would address the problem. Keneally noted that there are also several regional tax task forces that are moving forward to find and prosecute identity thieves. The Department of Treasury, Department of Justice and the U.S. Attorney’s offices are all cooperating.


In addition, the IRS is updating its computer software. If there are multiple refunds to one address or indications that the refund may not be appropriate, the software will “flag” the return for greater review.


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