In 2020, telehealth became a vital lifeline for both providers and patients. Rapid ramp up was met with regulatory relaxation to allow care interactions to continue amid emergency declarations. And a year later, with telehealth expansion finalized, at least in part by CMS, it’s become vital to accurately assess the risks and rewards that come with providing telehealth services.
In this post, we recap the recent statement by HHS-OIG and offer a few tips for ensuring your telehealth services uphold program integrity and protect patients.
HHS-OIG Principal Deputy Inspector General Christie Grimm issued a statement February 26 about the agency’s ongoing analysis of telehealth services and fraud schemes. Provided below are the highlights.
Telehealth in a Post-COVID World
Telehealth Fraud Risks
The Justice Department is actively already pursuing fraud within telehealth, recently reporting a massive takedown of hundreds of individuals defrauding both federal programs and private payers of $4.5 billion via telehealth.
Inspector General Grimm acknowledged the risk in light of current telehealth flexibilities:
“OIG is conducting significant oversight work assessing telehealth services during the public health emergency. Once complete, these reviews will provide objective findings and recommendations that can further inform policymakers and other stakeholders considering what telehealth flexibilities should be permanent. This work can help ensure the potential benefits of telehealth are realized for patients, providers, and HHS programs. We anticipate the first work products to be published later this year.”
Telehealth Fraud vs. Telefraud
Inspector General Grimm made a useful distinction between fraud involving telemedicine and fraud related to telemarketing schemes.
“In the last few years, OIG has conducted several large investigations of fraud schemes that inappropriately leveraged the reach of telemarketing schemes in combination with unscrupulous doctors conducting sham remote visits to increase the size and scale of the perpetrator’s criminal operations. In many cases, the criminals did not bill for the sham telehealth visit. Instead, the perpetrators billed fraudulently for other items or services, like durable medical equipment or genetic tests. We will continue to vigilantly pursue these “telefraud” schemes and monitor the evolution of scams that may relate to telehealth.”
Telehealth Credentialing and Ongoing Monitoring
Credentialing and ongoing monitoring of any employee or provider accessing or billing for telehealth is crucial to maintaining compliance and keeping patients safe. That’s why we have made sure our products continuously adapt to changing and delayed license expiration dates due to public health emergency orders.
To evaluate your current telehealth licensure processes, check out our Telehealth and Credentialing Guide. Let us know if you’d like to learn more about how ProviderTrust can help alleviate the burden of keeping up with the latest telehealth licensure on an ongoing basis.