Telehealth has become such an important part of our lives that it’s now second nature for many medical practices. That doesn’t mean you can become complacent, however. The reality is that auditors are still scrutinizing telehealth claims to look for instances of wrongdoing, and several recent cases highlight how telehealth fraud scrutiny may even be increasing.
Check out several recent telehealth fraud cases to get a feel for what the OIG is investigating so you can stay on the right side of the law.
Nurse Practitioner Charged With $7.8M Telehealth Fraud Scheme
Earlier this month, a nurse practitioner (NP) in Virginia was charged with a $7.8 million fraud scheme involving telemedicine. According to the Department of Justice, the NP signed orders for durable medical equipment (DME) being prescribed to Medicare beneficiaries, even though the NP had no connection to the patients. After she signed the orders, the DOJ alleges that a third-party telemarketing organization sold those orders to DME labs and suppliers, which later sent the claims to Medicare. The NP faces up to 10 years in prison and a fine up to $250,000 if convicted of the allegations.
The takeaway: Coders, billers and practice managers should always make sure that the documentation supports any DME claim before submitting it. If the provider who signed the orders has no history with the patient, the claim deserves a second look, and if fraud is suspected, bring it to the attention of another staff member right away.
Consultants Charged With $73M in Wrongful Telehealth Consults
In another case, two consultants in Florida were charged with $73 million in telehealth fraud. The pair of men gave telehealth providers access to Medicare beneficiaries for whom they could bill telehealth consults, in exchange for laboratory referrals. The lab then performed and charged expensive and medically unnecessary cardiovascular and genetic testing at the lab and billed it to Medicare, the DOJ said.
Takeaway: If your providers begin performing telehealth consults for multiple patients that all seem to be coming from the same source and who are new to your practice, that may be a red flag that inducements or inappropriate referrals are occurring. In this case, it may be beneficial to dig deeper and ensure that everything is on the up and up.
Doctor Charged With Prescription Fraud Via Telehealth
A doctor in New Jersey was charged with health care fraud after using telehealth to prescribe expensive compounded medications such as metabolic supplements, pain cream, migraine cream and scar creams that weren’t always medically necessary, the DOJ noted.
Telemedicine firms sent the doctor prescriptions for compounded drugs, and the doctor allegedly signed them, despite having no relationship with the patients involved. The physician simply signed the prescriptions but the telemedicine firm actually pre-filled them, the allegations say.
Takeaway: The doctor should always have documentation behind the “why,” no matter what service is being provided. If you’re unable to find a reason for a patient being prescribed a particular medication, it’s a good idea to take a closer look at the documentation and raise a flag with your colleagues if you suspect fraud is happening at your practice.
Keep your telehealth income flowing and avoid OIG scrutiny with actionable billing and coding tips from expert Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO. During her one-hour online training, Stop 2023 Telehealth Billing and Coding Errors to Keep Cash Flowing, she’ll provide you with the strategies you need to succeed. Sign up today!
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