Introduction
With the development of many technologies, visiting physicians in person is no longer always necessary. What could only be accomplished by an in-person visit can now be done via the internet or phone, such as by having a video call with a doctor. This trend only increased with the arrival of the Covid-19 pandemic. To avoid in-person appointments and, in turn, diminish the possibility of contracting Covid-19, telehealth has boomed to proportions never seen before. Despite the many advantages offered by telehealth, these kinds of medical interactions lend themselves to the unscrupulous practices of those who want to personally enrich themselves at the expense of others and government-sponsored health insurance programs. In its fight against these kinds of frauds, the federal government uses the False Claims Act as a primary tool.
Telehealth Fraud
With the development of internet technologies and alternate means of communication, such as video calls, telehealth has grown exponentially during the last several years. Promoted to avoid unnecessary in-person medical visits, many individuals have preferred this means to obtain medical consultations and services. Many view it as a more convenient form of receiving medical services by eliminating transportation to and from a physician’s office and reducing the exposure to diseases present while visiting an office. With the arrival of the Covid-19 pandemic, this trend only increased. Given the contagious nature of Covid-19, it makes sense not to have to visit a medical facility in person if alternate means, such as telehealth, are available.
The Centers for Medicare and Medicaid Services (CMS) relaxed several rules applicable to telehealth to facilitate these practices. Additionally, billing codes were added for telemedicine so that patients could receive these services for a wide range of medical conditions. Before the pandemic, patients with Medicare and Medicaid had limited options when trying to receive medical services via telehealth. Once the pandemic is over, CMS will have to decide if these changes will remain or if they will go back to previous policies regarding telehealth.
Despite the many benefits of telemedicine, it also allows for many new forms of fraud and corruption. For example, it has been found that some companies involved with telehealth have approached unscrupulous physicians that are willing to write unnecessary prescriptions and orders for patients without even seeing them or evaluating their medical needs. These companies then pay the physicians a share for these fraudulent medical services. Other schemes involve prescribing unnecessary tests or billing for tests that are never even carried out. Lastly, some have involved companies sending unnecessary or unrequested durable medical equipment. Although these frauds existed before, telehealth has allowed them to occur much more frequently and on larger scales. This particularly since parties committing these frauds can allege that they saw and evaluated patients via various means, and are no longer required to see them in person.
Federal False Claims Act
The Federal False Claims Act is one of the primary tools used by the government to combat fraud. In essence, it allows the government to go after individuals or entities that fraudulently submit claims for payment, recovering the amounts paid fraudulently. Although used in many situations, it is widely used when health fraud occurs against government-sponsored health insurance, such as Medicare or Medicaid. For example, if a physician bills Medicare for medically unnecessary services and receives payment, the government can sue the physician to recover these fraudulently paid amounts. In addition, the False Claims Act includes a whistleblower provision, known as qui tam, which allows a whistleblower to file a complaint on behalf of the government, providing evidence they may have on the fraud. This qui tam provision is essential since the government often does not have the necessary information to know that fraud is occurring.
Conclusion
With the development of certain technologies and the onset of the Covid-19 pandemic, telehealth has gone from being the exception to the new normal. Unfortunately, despite the many benefits it brings, left unchecked, telehealth can become rife with fraud. To combat this fraud affecting government healthcare, such as Medicare, Medicaid, and TRICARE, the government has the Federal False Claims Act at its disposal. This tool allows the government to recover fraudulently paid out monies. It also allows whistleblowers to come forward, filing a complaint on the government’s behalf, with any information and evidence that they may have. As an incentive, whistleblowers are entitled to receive a percentage of any amounts eventually recovered by the government. The law also protects whistleblowers by prohibiting any retaliation that they may suffer from blowing the whistle.
If you have information on telehealth fraud, please contact our firm. We will review your matter and any evidence you may possess to determine if a complaint may be viable under the False Claims Act. Our firm will evaluate your case free of charge.