Telehealth Emerging As A New Field Of Healthcare Fraud
Telehealth (also known as telemedicine) has seen a pronounced rise in usage due to the Covid-19 pandemic. Pre-pandemic telehealth use was limited and had strict restrictions regarding billing to Medicare. Since the outset of the pandemic, the Centers for Medicare & Medicaid Services (“CMS”) has rapidly embraced telehealth and, as a result, has eased its strict regulation of online medical services. This swift adoption of telehealth has allowed providers to adapt to the unique conditions presented by the pandemic quickly, but as explained by an experienced whistleblower lawyer from Hoyer Law Group, this has also made such services vulnerable to fraud and abuse.
Early in the pandemic, CMS attempted to make telehealth more accessible to both providers and patients. CMS achieved this by adding numerous billing codes relating to telemedicine, which significantly widened the range of services doctors could provide remotely. Notably, CMS temporarily allowed certain providers to waive patient deductibles and copayments. Typically any waiver of deductibles or copayments by a provider constitutes a violation of the False Claims Act’s (“FCA”) Anti-Kickback Statute.
What is Telehealth Fraud?
As part of the regulation easement mentioned above, CMS issued telehealth pandemic waivers to healthcare providers. These waivers awarded providers special rights regarding how they could administer telehealth services. These CMS waivers allowed:
- All providers to bill Medicare for professional services to provide telehealth services;
- Providers to conduct audio-only telehealth services in certain circumstances;
- Physicians to write prescriptions following a telehealth consult;
- Physicians and non-physician practitioners to offer telehealth options for visits to nursing home residents, which traditionally required in-person services; and
- Physicians and other practitioners render telehealth services from their homes without reporting their home addresses on their Medicare enrollment.
Pre-pandemic, CMS limited telehealth fraud via heavy regulation and the lack of Medicare billing options. However, the rapid expansion of telehealth services and the greater accessibility to government funds means that the field is increasingly vulnerable to fraud. Therefore, telehealth fraud has become significantly more widespread, mirroring other forms of pre-pandemic healthcare fraud. A few types of telehealth fraud are:
- The writing of medically unnecessary prescriptions or orders for Medicare beneficiaries without adequately evaluating their condition;
- Kickbacks paid to providers to solicit referrals for healthcare services or treatment;
- False billing or up-coding for medical treatment and services;
- Billing for services not rendered;
- Billing for unnecessary or non-existent screening tests for medical conditions; and
- Procuring unnecessary medical equipment for Medicare beneficiaries who don’t need it or didn’t request it.
Cases regarding telehealth fraud present unique challenges, mainly regarding the clarity of emergency pandemic measures. Regardless of the area’s legislative complexity, recent cases surrounding telehealth fraud prove that lawsuits are prosecutable and provide viable claims under the FCA. Therefore the fields of telehealth and telemedicine will continue to offer new opportunities for relators to report healthcare fraud and the misuse of government funds.
How We Can Help
An experienced whistleblower attorney can help you determine the validity of your whistleblower claim, guide you through the submission process, and fight for your rights if your employer retaliates.