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Telehealth fraud – Scams spreading online
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Telehealth Fraud – Scams Spreading Online
Telehealth services have exploded during the pandemic, bringing convenience and improved access for many patients. However, with this rapid growth there has also been an uptick in scams and fraud exploiting telehealth platforms. Government agencies are scrambling to address this emerging threat.
Telehealth fraud ranges from false claims, to miscoding services, inaccurate billing, and illegal kickbacks. The money involved is staggering – over $1 billion in fraudulent telemedicine claims in just one recent case!
How Do These Scams Work?
There are a variety of tactics telehealth scammers use:
- Up-coding – Billing for more complex services than were actually provided
- Misrepresenting Services – Charging for services or consultations that did not occur
- Unnecessary Testing & Equipment – Ordering excessive, unneeded lab tests or medical devices and billing insurance
- Kickbacks – Doctors receiving illegal bribes for referring patients to telemedicine companies
Some schemes involve overseas telemarketing centers that use deceptive sales tactics to get seniors and disabled patients to agree to expensive genetic testing that is not medically necessary.
Lack of Safeguards
The rapid expansion of telehealth during COVID-19 unfortunately outpaced fraud protections and oversight. Regulators have been playing catch-up, as billions in questionable claims have already been paid out.
In one recent audit, $127 million in likely fraudulent telehealth claims were identified in Medicare in just the first year of the pandemic. But this is likely only the tip of the iceberg.
The OIG found 41 providers associated with shady telemedicine companies accounting for much of this suspect billing. However, Medicare’s data systems don’t systematically track which claims originate from telehealth visits, hindering oversight.
Warning Signs of Scams
The OIG outlined common red flags of fraudulent telemedicine arrangements:
- Aggressive recruiting of patients for telehealth using TV/radio ads or telemarketing
- Ordering excessive tests per patient without medical need
- Routinely waiving patient copays
- Paying kickbacks for patient referrals
- Using independent contractor physicians (reduces accountability)
- Recruiting new telehealth patients from existing patient rolls
If a provider exhibits multiple issues from this list, they likely warrant investigation. Unfortunately regulation hasn’t kept pace with the rapid industry changes.
Cracking Down on Scams
Federal agencies are now focused on disrupting major telehealth fraud networks. The DOJ recently announced criminal charges against 36 defendants accused of over $1.2 billion in fraudulent claims.
The FBI also issued an alert warning seniors about phony telemedicine schemes promoting unneeded genetic testing.
State and federal regulators still have significant work to do updating telehealth rules and coordinating data systems to enable better oversight. Patient education is also key so individuals can better identify potential scams.
While telehealth offers significant patient benefits, regulators lag behind the rapid pace of industry change. This enables fraudsters to take advantage. Though belated, agencies are now focused on disrupting major fraud networks. Patients also need better education to identify scams.
Telehealth is here to stay, but updated rules, coordinated data systems, and public awareness can help reduce fraud…while still enabling access to care.