May 26, 2021
Today, the Department of Justice (DOJ) issued a statement consistent with the federal government’s record of falsely creating the impression that telehealth is uniquely vulnerable to criminal behavior. No federal regulator or oversight body has yet issued a comprehensive study of telehealth claims during the pandemic, yet the agencies continue to send out charged statements with misleading headlines.
The reality is that the majority of instances of fraud highlighted by DOJ today in its “2021 National COVID-19 Health Care Fraud Takedown” have nothing to do with telehealth. The one case of alleged fraud billed as telehealth-related by the DOJ represents behavior that just as easily occurs in in-person settings. The HHS OIG has previously clarified that tele-fraud does not constitute telehealth fraud, and that their work to examine telehealth continues.
Over the first eight months of the pandemic, utilization of telehealth services in Medicare FFS sharply increased from about 325,000 services in mid-March to a peak of nearly 1.9 million services in late-April. As people began going back to in-person appointments, utilization of telehealth dropped. In early June there were 1.3 million billed telehealth services and the number of visits declined through mid-October.
These visits represent billions of Medicare dollars appropriately spent on telehealth visits. In today’s notice, DOJ indicates that it has uncovered $550,000 associated with false telehealth claims during the COVID-19 pandemic, which were associated with a broader scheme related to unnecessary genetic screenings. That represents an impossibly small fraction of a fraction of a percent of the total dollars appropriately spent on care for Medicare beneficiaries – providing treatments necessary during the pandemic, ensuring continued access to primary care, behavioral health, chronic disease management Imagine the secondary health catastrophe we would be facing right now if all Medicare beneficiaries had forgone chronic disease management services for an entire year.
To put these findings into further context, during the 2019 fiscal year, the Federal Government won or negotiated over $2.6 billion in judgments and settlements in health care fraud cases and proceedings. The level of telehealth fraud identified today does not seem to rise to the level of the “National Rapid Response Strike Force.”
Finally, contrary to the popular perception that there are many unscrupulous telehealth providers setting up shop to bilk Medicare, in a large survey conducted by the COVID-19 Taskforce, 83% of seniors saw their own doctor by telehealth. Eight percent saw a doctor in their provider’s practice, and 1.4% saw a provider recommended by their insurer. A mere 1% saw a doctor through an app or online service that they identified themselves. This hardly constitutes telehealth “mills” turning out false claims.
The Alliance for Connected Care continues to support efforts to root out health care fraud across all modalities, including telehealth and virtual care. To date, neither DOJ nor HHS OIG nor any other oversight body has identified a pattern of fraudulent behavior unique to telehealth as a modality of care.
We urge policymakers to read the fine print on these cases and develop interventions that are an appropriate level of response to the fraud challenges identified.