HHS Issues Fraud Alert to Caution Providers Against Telehealth Cons

To battle telehealth fraud, waste, and abuse, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) composed a special fraud alert that provided guidelines for collaborating with telehealth companies.

Throughout the rapid uptake of telehealth during the COVID-19 pandemic, cases relating to fraud and abuse also grew. These can lead to billions of dollars in losses to taxpayer-funded federal healthcare programs and have adverse effects on beneficiaries.

For example, in the last few years, the OIG and Department of Justice (DOJ) have investigated several criminal, civil, and administrative fraud cases that involve telemedicine companies providing kickbacks to healthcare practitioners who ordered medically unnecessary items or services reimbursed by federal healthcare programs.

To combat these fraud risks, HHS-OIG issued a special fraud alert that explained how to take caution when working with telehealth companies, along with a description of potential indicators of fraud.

The first suspect characteristic in a telehealth arrangement relates to ordering items by a telehealth company through low-budget channels, such as the internet or television.

The second notes that limited contact between a provider and a patient leading to poor evaluation of services is a red flag.

The third relates to cases where a telehealth company reimburses a practitioner according to the number of services ordered — this is a potential indicator of fraud.

The following three suspect characteristics all relate to the extent to which telehealth companies furnish products. The report warned that telehealth companies that only provide services to federal healthcare beneficiaries or those who bill federal health insurers and only do so for one type of service might be suspect.

Finally, if a telehealth company does not alert a practitioner of a necessary follow-up, it may indicate fraud.

"…OIG encourages Practitioners to use heightened scrutiny, exercise caution, and consider the above list of suspect criteria prior to entering into arrangements with Telemedicine Companies," the fraud alert states.

This year, the DOH has taken enforcement actions against various telehealth fraud schemes.

For example, in April, the DOJ charged orthopedic surgeon Elemer Raffai for participating in a telehealth fraud scheme, which involved Raffai allegedly submitting false claims to Medicare in exchange for bribes and kickbacks.

In May, the two owners of a telehealth company called RediDoc LLC pleaded guilty to healthcare fraud. The complex scheme resulted in fraudulent claims totaling more than $64 million submitted to healthcare benefit programs.

Motivation for these actions often derives from the increased demand and use of telehealth. Thus, healthcare practitioners must remain vigilant. 

In a Healthcare Strategies podcast released in June, Jacob Harper, an associate with the law firm Morgan, Lewis, & Bockius, noted that providers must be attentive to how they use telehealth throughout periods of changing regulations and prevalent frauds.