Telehealth fraud appears to be on the rise, as more patients are opting into virtual appointments with their physicians via audio and video technology, Legal Reader reports.
Five things to know about telehealth fraud:
1. Numerous states have their own laws and regulations for telehealth services, so Medicare or Medicaid patients should check whether their state insurance can reimburse for telemedicine transactions.
2. Telehealth fraud initially began with improper coding and billing of services, which grew through practices such as claims from non-eligible or non-listed institutional providers as well as claims from unacceptable means of communication.
3. Telehealth transactions are susceptible to kickback measures. An example of this is the federal government's recent charging of 24 defendants, who included top executives from telehealth companies and owners of medical equipment companies, for their alleged participation in a $1.2 billion telehealth fraud scheme.
Federal prosecutors claim telemarketers would call Medicare beneficiaries to get them to accept free or low-cost DME braces, regardless of medical necessity. The telemarketers would transfer the beneficiaries to telehealth companies for consultations, and those physicians would allegedly prescribe the orthopedic braces to patients without in-person consultations. The alleged defendants received kickbacks from the medical brace companies.
4. Physicians are the most common victims of telehealth schemes, according to the report. Physicians' names and accounts can be used to collect payment from insurance companies for patients who haven't visited the clinic in-person yet.
5. Fast daily patient turnover rates, difficulty communicating with the clinic's management and issues with contacting patients are some signs physicians can look out for to avoid becoming a victim of a telehealth scheme.
To access the full report, click here.