Explosion of Telehealth Usage Makes it a Target for Fraudsters
The Covid-19 pandemic has caused a dramatic increase in the use of telehealth services, and this higher usage is likely to continue in the future.
In 2019, before the pandemic, 840,000 Medicare telehealth services were received by 910,000 unique Medicare telemedicine beneficiaries. From March 2020 to February 28, 2021:
- 52.7 million Medicare telehealth services were received by 28.2 million unique Medicare telemedicine users.
- 53% of Medicare users used telehealth.
- 44% of Medicare’s telehealth services are provided in rural areas, and
- 55% of Medicare’s telehealth services are provided in urban areas.
Increased use of telehealth creates a situation that is ripe for fraud. The unique nature of telehealth services presents a high risk that providers may bill Medicare or Medicaid for unreasonable, unnecessary, or otherwise non-covered services.
The United States Department of Justice (“DOJ”) and the Centers for Medicare and Medicaid Services (“CMS”) are concerned about misuse of telehealth services, and actively investigate and pursue those who abuse the programs. And there are big numbers in those fraud pursuits:
- National Law Review: DOJ charged 50 medical professionals in 11 judicial districts with $1.1 billion in telemedicine fraud.
- Dept. of Justice: A Brooklyn physician was charged in a $10 million telemedicine fraud scheme.
- Dept. of Justice: A Florida telemedicine provider was charged with committing a $784 million fraud.
- Dept. of Justice: Four people were indicted in an international kickback and telemedicine scheme.
An individual who learns of telehealth fraud should speak with an experienced whistleblower attorney to analyze the situation and consider whether his or her information would support a whistleblower lawsuit under the False Claims Act.
Written by Regina Poserina and Raymond M. Sarola of Cohen Milstein Sellers & Toll. Edited by Matthew Beddingfield of Zerbe, Miller, Fingeret, Frank & Jadav and Tony Munter of Price Benowitz. Fact checked by Julia-Jeane Lighten of Taxpayers Against Fraud.
