September 23, 2021. The unscrupulous actors racing to the bottom of despicable healthcare fraud have set a new floor. A recent nationwide federal law enforcement action resulted in criminal charges against almost 140 medical professionals in 31 districts across the United States for telemedicine fraud, COVID-19 health care fraud, substance abuse treatment facilities fraud, and illegal opioid distribution schemes. Of these, the telemedicine fraud outpaced the amount of the other fraud schemes by more than three times the amount of fraud loss.
According to the allegations, 50 criminal defendants in 11 judicial districts billed over $1.1 billion in false and fraudulent telemedicine-related claims to Medicare. At the onset of the pandemic, Medicare expanded telehealth rules, allowing providers to better connect with homebound elderly and vulnerable patients. Fraudsters took advantage of that expansion, and the DOJ has increased enforcement activity in this space, with the creation of the National Rapid Response Strike Force, which coordinated this most recent set of healthcare fraud takedowns.
In a February 2021, the Principal Deputy Inspector General at the Department of Health and Human Services Office of the Inspector General (HHS OIG) released a statement differentiating between telefraud and telehealth fraud, as OIG investigates both types of fraud. Telefraud involves “telemarketing schemes in combination with unscrupulous doctors conducting sham remote visits to increase the size and scale of the perpetrator’s criminal operations.” These telemarketing fraudsters do not bill for the telehealth visits themselves but instead bill government-funded healthcare programs for (often medically unnecessary) durable medical equipment or genetic tests.
Fraudulent manipulation of telemedicine harms Medicare beneficiaries’ future virtual provider access. As the COVID-19 pandemic has shown in some regard, virtual access to care can be beneficial to patients with limited mobility or to immunocompromised patients. As long as someone has Internet access via a mobile phone, telehealth can “level the playing field,” as it were, in providing access to care to a broad range of people. HHS OIG supports increased telehealth flexibilities, with a 2019 study showing that “telehealth can be an important tool to improve patient access to behavioral health services.” HHS OIG also has to ensure “new policies and technologies with potential to improve care and enhance convenience achieve these goals [without being] compromised by fraud, abuse, or misuse.” Their reviews of telehealth expansion for government-funded healthcare programs “will provide objective findings and recommendations that can further inform policymakers and other stakeholders considering what telehealth flexibilities should be permanent.”
Whistleblowers can help make sure these emerging medical technologies steer clear of fraud, waste, and abuse. Whistleblowers who report fraud against government programs may be entitled to receive 15-25% of the government’s recovery.