No doubt about it, 2020 has been a banner year for telemedicine and connected care solutions. This boom was, of course, kickstarted by the COVID-19 pandemic (though it is now obvious it will not end with it). A surge of new state and federal legislation continues to be passed in order to solidify this widespread adoption of telemedicine. From reducing physician burnout to helping practices meet new patient preferences for connected care options, telemedicine solutions have proven to be highly beneficial for both providers and patients.
As with many things, however, with the good there will almost always be at least a little bit of bad. Telemedicine, it would seem, is not immune to this. In recent months, a number of bad actors have been caught using telemedicine solutions to commit fraud… and the authorities are cracking down hard. In this blog, we will take a look at the recent state of fraud in telemedicine and offer advice on how to avoid and (if necessary) report it to the proper authorities.
DOJ & CMS Are Tackling Telemedicine Fraud
The motivation for telemedicine fraud is pretty much the same as it is for any criminal enterprise—it’s all about the money. In just the last year or two, these schemes have pulled in billions of dollars for bad actors. You read that right… billions (not millions) of dollars. However, it looks like the gravy train is coming to a stop, because authorities are now coming down hard on telemedicine fraud.
In recent weeks, hundreds of individuals have been hit with charges due to their participation in various telemedicine fraud schemes. The crackdown first began on September 27, 2020, with the Department of Justice’s (DOJ) announcement that charges had been filed against 35 individuals involved in a telemedicine scheme in which they allegedly deceived Medicare beneficiaries into signing off for (rather expensive) cancer screenings and genetic tests that they did not need, raking in $1.7 billion in false claims.
Just a few days later, on September 30, 2020, the DOJ announced the largest single healthcare fraud bust in the department’s history. A total of 345 individuals (including 10 medical professional and 9 doctors), from dozens of telemedicine companies and labs, were charged for alleged participation in one of the most widespread fraud schemes ever hatched, totaling $2.1 billion in losses. This scheme used the same methods as that alleged in the September 27th announcement.
That same day, the DOJ also announced charges against 86 individuals alleged to be involved in a $4.5 billion telemedicine fraud scheme in which doctors and nurses were paid kickbacks. According to the indictment, executives from multiple telemedicine firms paid (or you could say bribed) physicians and nurses so they would order genetic/diagnostic testing, prescribe opioids and order expensive medical equipment without proper authorization from or interaction with patients. In total, the defendants in this indictment submitted $4.5 billion in false and fraudulent claims. In response, CMS revoked Medicare billing privileges from 256 of the medical professionals who received these kickbacks.
Avoiding & Reporting Telemedicine Fraud
The method for avoiding becoming involved with telemedicine fraud is simple—just don’t do it. Know the state and local laws and regulations regarding the legal use of telemedicine. Be skeptical of any monetary rewards being offered to you by a telemedicine company and stick to the old saying, “If an offer seems too good to be true… it isn’t true.” If you are even slightly unsure as to the legality of any telemedicine enterprise, you should consult with your practice’s legal counsel before getting involved.
Perhaps you are not involved in telemedicine fraud but have witnessed it being done by another practice, provider and/or colleague? In such a case, it is probably in everyone’s best interest to report the situation to the proper authorities so it can be investigated. To report suspected telemedicine fraud, individuals should reach out to the Department of Justice by using the contact form at this link.
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