WHAT IS TELEMEDICINE?
Telemedicine is also known as telehealth, which relates to the distribution of health care services and information using internet and telecommunication services. It allows for remote clinical services which can allow a doctor and patient to have contact through webcam on a computer or cell phone. In most circumstances, telemedicine was primarily used in situations where meeting with a doctor was difficult or impossible due to distance, lack of transport, or lack of patient mobility. Telemedicine has historically also been an option to provide service during times of decreased funding or insufficient staff allowing a medical care provider to service their patients until the provider is back at normal capacity. Historically, Medicare and Medicaid only paid for telemedicine services in limited circumstances. The COVID-19 pandemic has completely transformed the availability and rate of usage of telemedicine in the United States as Medicare and Medicaid have waived many requirements and restrictions of telemedicine due to the difficulties of meeting safely in person. This has resulted in an increase of nearly 4,000 % in Medicare beneficiaries using telemedicine in the past 6 months. It is estimated that the telemedicine industry has the potential to balloon from a $3 billion industry to a $250 billion industry if current trends continue. This explosion in telemedicine use has also opened the door to various types of telemedicine-related health care fraud, which have drawn the attention of the Department of Justice (DOJ). If you are facing a federal health care fraud investigation or charges, then it is important to speak to an experienced federal health care fraud attorney as soon as possible.
WHAT ARE SOME EXAMPLES OF TELEMEDICINE FRAUD?
As telemedicine has exploded in popularity and usage, so have the criminal schemes and activity by health care providers trying to profit. Even before the pandemic, the DOJ was auditing health care provider’s usage of telemedicine and found that almost 1/3 of telemedicine claims were not up to regulation. Telemedicine is now being used a vehicle to help carry out various forms of health care fraud. One such example is that of illegal kickbacks. Under the federal anti-kickback law (42 U.S.C. § 1320a-7b), health care providers are not allowed to pay, induce, or receive referrals for medical services that are reimbursed by federal health care programs like Medicaid or Medicare. In a recent case, a telemedicine company allegedly promised a free COVID-19 test in exchange for a TRICARE patient’s personal information. The company then allegedly used the information to prescribe unnecessary medicine and medical equipment in exchange for millions of dollars in illegal kickbacks. It is also alleged that the patients never got their COVID-19 tests and the telemedicine company received massive payouts from TRICARE for the unnecessary prescriptions. Other illegal kickback telemedicine fraud cases have involved Medicare and Medicaid. An example of this includes a case where a telemedicine company made an agreement to receive illegal kickbacks from labs for referring completed COVID-19 tests. These examples show just a couple of the types of telemedicine fraud that are emerging since the start of the COVID-19 pandemic.
DEPARTMENT OF JUSTICE TAKEDOWNS
The United States DOJ recently announced the largest health care fraud takedown in our country’s history, alleging more than $6 billion in health care fraud, and resulting in over 300 people being criminally charged. Some of the main targets of this DOJ takedown were telemedicine providers. The fraud alleged among telemedicine providers in these cases includes allegations of illegal kickbacks for prescribing unnecessary opioids, genetic testing, and referring patients to substance abuse rehab centers. It is expected that the title of “largest health care fraud takedown in US history” will be short lived, as the DOJ has intensified its focus on telemedicine and are pushing significant investigation resources towards the investigation and prosecution of major federal health care fraud cases. If you are a telemedicine health care provider, it is recommended that you take proactive steps and extra compliance measures to make sure that you do not become a party to illegal activity. If you have any questions related to telemedicine-related health care fraud, then call us at Bajoka Law so we can help.
