The Dark Side of Telemedicine
The sudden increase in demand for telemedicine services has created new opportunities for fraud and abuse.
In the past 3 weeks, Feds have charged almost 350 people for submitting $6 billion in fraudulent claims. One of the largest initiatives, Operation Rubber Stamp, targeted a network of telemedicine fraud totaling over 4.5 billion in false claims. Operation Rupper stamp is the most-publicized action against telemedicine providers to date. A sting operation of this size adds a dose of reality and caution against telemedicine’s many benefits.
Back in the spring, in the early stages of COVID-19, policymakers loosened up on longstanding telemedicine regulations. Telemedicine had traditionally been envisioned too to serve patients with urgent needs who lived in hard-to-reach rural areas so that they could continue to receive medical care for chronic conditions. CMS was rarely allowing billing outside of these guidelines.
The pandemic left policymakers scrambling to relax regulatory policies to allowed providers the opportunity to continue to treat patients while clinics and medical practices closed. Federal officials allowed telemedicine providers to waive patient deductible and copayments. Providers were also allowed to be reimbursed on various virtual platforms, such as Zoom, FaceTime, and Skype. These new guidelines removed barriers to entry and allowed many new players to enter the market.
Ambiguous Doctor-Patient Relationship
The biggest concern in the current telemedicine landscape is for providers to claim a doctor-patient relationship that does not exist. A common theme in fraud cases has been providers who are willing to establish only a cursory patient-physician relationship and order medical supplies or equipment in order to engage in kickback schemes from a device supplier or laboratory.
Telemedicine waivers are likely to continue in their current state as lawmakers are being pressured to make the changes permanent. While there are obvious benefits for more efficient and cost-effective care, there are ampler opportunities for abuse in telemedicine as well. Illegal online pharmacies, kickbacks schemes, and aggressive marketing schemes targeting vulnerable populations are a few of the many potential threats to defraud Medicare. Cases such as Operation Rubber Stamp are likely just the beginning of many investigations by the Feds and should serve notice to bad actors looking to taking advantage of the new guidelines.
Vipul Kella is a board-certified emergency physician. In addition to 15 years on the front lines of health care, he has served 10 years as a hospital executive. He has held numerous expert consulting roles over the past years, specifically focusing on standard of care matters, negligence, fraud and abuse, and hospital administration cases.
Copyright Vipul Kella, MD MBA FACEP
Disclaimer: While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer.For specific technical or legal advice on the information provided and related topics, please contact the author.