Advocacy Alert: Regulators Turn Their Eyes to “Tele-Fraud”

August 11, 2022

via Nelson Hardiman

On July 20, 2022, the Office of the Inspector General for the Department of Health and Human Services announced a Special Fraud Alert on the subject of "tele-fraud" (telehealth-related fraud). The trend towards greater focus on prevention and enforcement activity against telehealth fraud has been almost inevitable. The Covid-19 pandemic acted as a galvanic force for widespread adoption and third-party payer coverage for telehealth services. As is universally the case when the government and payers expand coverage, healthcare "profiteers" looking to exploit the new opportunity moved into telehealth. The result is that an initial new "door opening" shifts into a phase of rooting out fraud and abuse.

With the public health emergency related to Covid-19 winding down, the government infrastructure that has already been shifting to examine Covid-19-related fraud and abuse more generally is also being redirected in a long-term manner toward telehealth. In part, this can be seen as part of the "normalization" of telehealth across multiple government agencies. From the Centers for Medicare and Medicaid Services (CMS) to the U.S. Department of Justice (DOJ), there appears to be recognition that, in the post-pandemic era, telemedicine will be a permanent feature of government-funded U.S. healthcare.

The recent Special Fraud Alert follows months of investigations, trial convictions, and reports related to telemedicine providers utilizing inducements and kickback to incentivize providers into ordering various medical tests and billing services that are deemed neither medically necessary nor clinically appropriate. The Alert details multiple types of "suspicious" activities that could signal fraudulent behavior.

You can learn more from Nelson Hardiman's alert here.

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