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Gov’t increases focus on healthcare fraud and telehealth services

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has increased its focus on healthcare fraud schemes involving telehealth services. The OIG began this increased focus in 2016. These efforts contributed to a massive takedown in September.

In this enforcement effort, the OIG arrested and charged 345 individuals including medical practitioners, pharmacy owners and telemedicine executives. The prosecution has accused these individuals of participating in healthcare fraud schemes that cost the government over $6 billion in losses. The OIG reports more than $4.5 billion of these loses are connected to telehealth services.

What were the allegedly fraudulent telehealth services?

According to the government, those involved in the alleged scheme were using “aggressive marketing” techniques to increase revenue. Examples include the use of telemarketing calls and internet advertisements. The prosecution has accused those running the scheme of paying medical providers to order medical equipment, testing and medications that were not medically necessary.

To make matters even worse, the government has accused these executives of using shell corporations and foreign bank accounts to launder the money – to remove the money from the alleged criminal activity. If evidence is present to support these allegations, in addition to healthcare fraud charges those involved could also face criminal charges for money laundering and, depending on the timing and details of tax reporting, tax crimes.

What can telehealth providers learn from this sting?

Medical professionals who are using telehealth services should see this enforcement operation as a call to action. The current pandemic has led to a sharp increase in the reliance of telehealth services. As such, medical professionals, pharmacists and other healthcare providers who were used to in-person appointments may find themselves navigating new methods to provide healthcare.

Those who are unfamiliar with this type of healthcare, and even those who have used it in the past, are wise to proactively conduct an audit to see if there are any concerns that the group may run afoul of applicable regulations. This audit can help to catch an issue before it becomes a larger problem. A failure to do so could result in a cascading issue that leads to a federal investigation and charges of criminal wrongdoing.

Tags: Health Care Fraud and Abuse ControlHealth Care Investigationshealth care business