WHAT IS TELEHEALTH FRAUD?
Telemedicine is the use of telecommunications, usually phone or video, to provide health care appointments and services remotely. Telemedicine fraud involves the use of virtual appointments or services to conduct fraudulent health care practices such as upcoding, unbundling, or medical necessity fraud.
Health services via telemedicine have spiked because of the COVID pandemic, and now the government is cracking down on fraudulent practices in telehealth. Largescale investigations and cases are making headlines, and whistleblowers who help expose these telehealth fraud scandals are being rewarded.
COMMON TYPES OF TELEHEALTH FRAUD
According to a recent study released in Health Affairs, the number of telemedicine visits conducted each week is 23 times higher than before the pandemic. Each of these virtual visits provides an opportunity for fraud, with even fewer eyes in the office to keep people honest and accountable.
Common types of healthcare fraud involving telemedicine include:
- Billing for services or medical equipment not actually provided
- Administering medically unnecessary services
- Encouraging or pressuring patients to accept medically unnecessary services
- Upcoding – billing for more costly services than those actually performed
- Unbundling – separate billing for services or procedures that should be combined as one
- Billing Medicare or Medicaid and the recipient for the same services
- Self-referrals and kickbacks
- Forging documents, appointments or prescriptions
In some cases, healthcare fraudsters may even offer a “free” telemedicine visit as a way to bring in vulnerable patients who may accept costly, and unnecessary, medical treatment or DME. It is also common for these fradulent service providers to prey on elderly people, pressuring them into unnecessary medical treatments or equipment .
HOW WHISTLEBLOWERS CAN GET COMPENSATION FOR SEEKING JUSTICE
Whistleblowers with evidence of past or ongoing telehealth fraud may be able to collect a substantial reward for reporting the illegal conduct. A federal case will often be launched to bring the responsible parties to justice for their fraudulent activities. If you’re ready to seek justice for telemedicine fraud it’s important to have an experienced lawyer on your side. Price Armstrong attorneys know successfully represent fraud whistleblowers and protect you from retaliation and abuse. Contact us for a free initial consultation and review of your potential case.
TELEHEALTH FRAUD FAQS
The Office of Inspector General for the U.S. Department of Health and Human Services will often investigate reports of telehealth fraud together with the FBI.
Review all billing, treatment or appointment summary notes, and explanation of benefits. If you work for a healthcare provider, you may be told by your employer to bill for telemedicine services that were inaccurate or not provided, or to change the coding when billing. This is against the law and should be reported.
It is important to have concrete evidence of telemedicine fraud before reporting it. While documentary evidence is not required, it is considered in many cases and can play a role in your case. Records of improper charges, emails stating fraudulent claims, or in-office memos can be helpful, however, there are important factors to consider before removing company documents. Our experienced qui tam attorneys can evaluate the evidence you have of telehealth fraud and help you navigate the rules about disclosure that ensure your rights are protected.
Simply reporting the fraud is often not enough to receive compensation for whistleblowing. You must formally file a claim in court and include evidence of the misconduct under the False Claims Act.
Under the False Claims Act, the government can choose to take over the case, called “intervention,” or can decline to do so. Less than 15% of cases are intervened in by the government. However, this is often due to factors that are unrelated to the strength of the case, the amount of information brought by the whistleblower, or the nature or extent of the telehealth fraud reported. Some qui tam lawyers will not represent you or pursue your case if the government declines to intervene.
CONTACT US FOR A FREE CASE EVALUATION
If you have evidence of past or ongoing telehealth fraud, contact the attorneys at Price Armstrong. We can help you seek justice and protect your rights throughout the process. We represent clients nationwide with three offices in Birmingham, AL, Tallahassee, FL and Albany, GA. Complete a form, start a chat or call us today at (205) 208-9588 for a free initial consultation and review of your case. Let us fight for you – call now!