While CMS has relaxed telehealth regulations to expand care during the COVID-19 pandemic, the action may result in a spike in billing fraud, according to an April 22 Kaiser Health News report.
In March, the Trump administration approved $500 million in waivers for Medicare telehealth restrictions, expanding coverage to all Medicare beneficiaries regardless of location. The president then further expanded Medicare coverage by adding 85 additional services covered when delivered via telehealth, including emergency department visits and nursing facility and discharge visits.
Telehealth providers can now waive patient deductibles and copayments during the COVID-19 emergency, however, under normal circumstances, such actions may be interpreted as a kickback because patients are discouraged "from complaining about charges or can lead to overuse of medical services," according to the report. The relaxed regulations could potentially cause a wave of billing fraud, especially if CMS makes some of the changes permanent.
“There are unscrupulous providers out there, and they have much greater reach with telehealth,” Mike Cohen, an operations officer with the HHS Inspector General’s Office, told the publication. “Just a few can do a whole lot of damage.”
Fraudulent activities could increase as telehealth phone operators can now target thousands of patients for services, and Medicare will have to differentiate false bills from bills submitted by legitimate telehealth providers. Last April, the Department of Justice charged 24 people for their alleged roles in a $1.2 billion telehealth scam that consisted of arranging physicians to order medically unnecessary equipment and treatments for Medicare beneficiaries.
Federal investigators are already seeing "tons" of fraud cases related to COVID-19, such as using patient accounts to bill for "coronavirus emergency kits" that comprise only gloves, hand sanitizer and fake testing kits, Mr. Cohen said.
CMS told KHN that it is "instructing its payment and audit contractors to review claims during this public health emergency based on all agency waivers and flexibilities that have been put into place. This includes claims for services furnished under the telehealth flexibilities.”
The agency also said it is placing a "strong emphasis" on integrity and cost in its considerations of whether to make any telehealth changes permanent.