Preparing For Growing Telehealth Fraud Enforcement
As federal agencies attempt to curb fraud, waste, and abuse within telehealth, policy experts recommend that providers stay up to date on regulatory changes and use best practices.
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By Anuja Vaidya
- As federal authorities increasingly crack down on instances of fraud and abuse within the telehealth arena, providers need to remain vigilant about their use of the care modality as regulations evolve.
That’s according to Jacob Harper, an associate with law firm Morgan, Lewis & Bockius, who along with Christa Natoli, executive director of the Center for Telehealth and E-Health Law (CTeL), and Ben Steinhafel, policy director of CTeL, joined Healthcare Strategies to discuss fraud enforcement related to telehealth.
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First, a key point to note when discussing cases of fraud, waste, and abuse involving telehealth is that there is a difference between telemedicine fraud and tele-fraud.
“Telefraud is where a person commits a fraudulent act using telecommunication technologies and telemedicine fraud is where a provider establishes a relationship with [a] patient and uses telemedicine to commit fraud,” Natoli said.
Two of the major cases being investigated by the Department of Justice involve durable medical equipment and the prescription of controlled substances, and there was no establishment of a practitioner-patient relationship in either case, she added.
But still, the cases did involve telehealth players. “I don't think we can ignore the fact that there is a telehealth component to them, I think we need to be realistic about that,” Harper said.
And at least one other case has involved a physician.
Further, the DOJ’s focus is shifting to fraudulent telehealth billing and claims, Harper said. In one recent case, the DOJ charged the owners of a nationwide telemedicine company for a scheme in which fraudulent claims totaling more than $64 million were submitted to healthcare programs.
In this enforcement climate, providers would benefit from hewing close to the age-old adage: prevention is better than a cure.
“I think taking affirmative steps to understand what the rules are right now and how best to implement them is going to be much easier to swallow than trying to defend non-compliance in the future on the basis that, ‘Oh, it was COVID-19 and it was a pandemic and I didn't know what was going on, and it wasn't really that bad,’” Harper said. “I think being proactive about ensuring that you're meeting the modality requirements in your state, that you're meeting licensing requirements in your state, all of that kind of stuff can go a long way to not even having to worry about these kinds of issues.”
