Growth of Telemedicine Sees Increase in Healthcare Fraud

Earlier this month, a New York anesthesiologist was indicted on charges stemming from her role in an alleged telemedicine conspiracy to submit fraudulent claims to federal and private insurance plans.

The indictment alleges that Anna Steiner, also known as Hanna Wasielewska, along with others, ordered and prescribed durable medical equipment (DME) and prescription drugs in connection with purported telemedicine services. She was arrested in April.

The alleged fraud is said to have started sometime around January 2015, during which she and other healthcare providers signed prescriptions and order forms for DME and drugs that were not medically necessary for beneficiaries that neither she nor the others had examined. The indictment alleges that she and others submitted, or caused to be submitted, more than $7 million in claims on behalf of more than 3,000 beneficiaries in exchange for kickbacks. Medicare paid out more than $3 million on those claims.

As telemedicine becomes more popular, the list of telemedicine services covered by Medicare also has grown. With that growth has come more opportunity for fraudulent behavior.

Last October, four people and seven companies were indicted in Tennessee in connection with a $1 billion telemedicine fraud scheme. And, in April 2019, the federal government announced that 24 people, including healthcare executives and others associated with five telemedicine companies, were indicted for their roles in a scheme that resulted in the submission of more than $1.7 billion in claims.

Kickbacks are just one area where telemedicine fraud has seen growth. Improper billing and coding is a big trigger for those investigating fraud. As early as 2017, the OIG added Medicare and Medicaid telehealth payment audits to its Work Plan, signaling its intention of additional scrutiny over the practice.

It followed up with a report released in 2018 that found 31 percent of a sample of 100 telehealth claims did not meet Medicare requirements.

The OIG estimated that had those services been provided in accordance with Medicare requirements, the government could have saved approximately $3.7 million.

Another area where providers can get into trouble is when they offer free products to patients. For example, a provider, be it a physician or a hospital, offers free remote monitoring devices to patients. There are some instances, as we wrote about here, when such tools can be offered for free or at a discount, but certain conditions must be met.

Telemedicine holds a great deal of promise, particularly for those in need of healthcare in underserved areas. For those providing such services, it is essential that all applicable state and federal rules be followed. The Health Law Offices of Anthony C. Vitale can assist you with these efforts and represent you should you become the target of an audit. Give us a call at 305-358-4500, or send an email to info@vitalehealthlaw.com and let’s discuss how we might be able to assist you.

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It is not intended as professional advice and should not be construed as such.