With the rise in telemedicine around the United States, the federal government is increasingly looking at telehealth-related fraud. Increasingly, key officials are outlining the government’s next steps. In light of this, healthcare providers who utilize telehealth platforms in the provision of care to Medicare and other federal healthcare program beneficiaries are well advised to take a fresh look at their telehealth operations.
Watchdog Raises Concerns
As reported by Stat, the federal government is sounding the alarm that Americans’ growing enthusiasm for telehealth services during the coronavirus pandemic has led a “dramatic increase” in telehealth-related fraud. It was reported HHS’s independent inspector general criticized policymakers for failing to put regulatory safeguards in place when they expanded access to telehealth in the Medicare program. Michael Cohen, the OIG’s director of operations, said the changes created an “open season” for vulnerabilities.
They “should have taken a couple of years to think about before it got rolled out, not roll it out, and then try to walk it back,” Cohen said. “This was probably not the best way to implement telemedicine.” Cohen said his office had seen a clear, measurable escalation of scams where providers might exploit the idea of a telehealth visit to get information out of patients that they could use to bill Medicare for unnecessary medical equipment or services, or telehealth companies paying providers to prescribe services without ever interacting with the patients themselves. He said the office was still studying whether other types of telehealth-related fraud had increased during the pandemic, like legitimate companies overbilling or providing less effective care.
Fraud Recovery
Right now, the federal government estimates that there were $4.5 billion worth of telehealth-related fraud losses in fiscal year 2020, the largest of any category and a record for Medicare fraud. More than 80% of the Department of Justice’s fraud recoveries in 2020 were health care-related, the largest number of government-initiated cases against health entities ever reported.
Several of those major cases were telehealth-related. In one case in Florida, the CEO of two telehealth companies pled guilty to soliciting bribes in exchange for encouraging telehealth providers to order unnecessary medical equipment. In another, a physician allegedly paid his friends to sign telehealth orders for medically unnecessary genetic testing and medical equipment.
With this in mind, we note on February 26, OIG published a statement on telehealth and fraud concerns, explaining “OIG is conducting significant oversight work assessing telehealth services during the public health emergency.” The goal of these reviews is to ensure “telehealth delivers quality, convenient care for patients and is not compromised by fraud.”
Moving Forward
Experts point out that in light of the continuing oversight and enforcement activity by the DOJ, the OIG and other government agencies, healthcare providers who utilize telehealth platforms in the provision of care to Medicare and other federal healthcare program beneficiaries are well advised to take a fresh look at their telehealth operations. By focusing internal compliance efforts on telehealth activities – including the conduct of internal audits focused on the mitigation of traditional fraud, waste, and abuse risks – providers may be better positioned to successfully answer telehealth compliance questions raised in the context of external audits.