7 things to know about rising telehealth fraud

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Telehealth fraud is costing the federal government billions of dollars. Physicians and telehealth company employees have been connected to several kickback schemes and making fraudulent Medicaid and Medicare claims, according to an Aug. 12 National Law Review report.

Seven things to know:

  1. Early in the pandemic, HHS said telefraud and opioid schemes targeting Medicare beneficiaries cost $6 billion in alleged fraud losses to Medicare and Medicaid.

  2. Telefraud was also around before the pandemic. However, telehealth visits rose 154 percent in the last week of March 2020 when compared to the year prior, the CDC reported. Increased telehealth use may create more opportunities for fraudsters.

  3. A telemedicine company owner was charged for submitting more than $784 million in false claims to Medicare, according to the report. The company owner and his co-conspirators solicited payments from medical equipment suppliers and paid physicians for medically unnecessary prescriptions from 2015-2018.

  4. In May, three telemarketing company owners were charged for their alleged participation in a $46 million scheme targeting Medicare beneficiaries, encouraging them to accept unnecessary cancer genetic tests. The physician orders were written by contracted physicians even though they had no prior relationship with the beneficiaries, were not treating the beneficiaries for cancer or symptoms of cancer, did not conduct a proper telemedicine visit, and did not use the test results in the treatment of beneficiaries.

  5. Officials from the HHS Office of Inspector General said at the recent HIMSS Global Health Conference 2021 that they're keeping an eye on telehealth.

  6. "As we expand telehealth, there are likely to be instances of large-scale criminal activity that takes advantage of this. And it’s up to OIG to assess those risks, and inform policymakers and stakeholders of those risks, and then from those policymakers and stakeholders to adjust," said Andrew Vanlandingham, senior counsel for Medicaid Policy and acting health IT lead at the inspector general's office.

  7. The report suggested offering whistleblowers who report telemedicine or telehealth fraud schemes t15 percent to 25 percent of money the government recovers. 

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