Reporting Fraud in Government Telehealth Programs Under the False Claims Act

By Mark Westin posted 10-22-2020 02:45 AM


Telehealth usage has skyrocketed this year due to COVID-19 after the relaxation of regulations about its use to accommodate this pandemic. Unfortunately, instances of cybersecurity risks, fraud, and abuse have also risen. Experts are monitoring the telehealth sector as these services are vulnerable to fraudulent practices. 

Most of them have been around for many years, but instances of such acts are rising. Telehealth services have been central to some of America’s most significant healthcare fraud cases, involving millions of dollars. 

What is telehealth program fraud?

Fraud occurs when the incorrect information is deliberately supplied to a service provider, allowing for larger claims. 

Examples include double billing, billing for two visits when one would have sufficed, submitting bills using codes that provide higher reimbursements, and over-treatment of patients. These practices are prevalent in government telehealth programs, where the volume of claims processed is vast.

Telehealth services have made a significant difference in the lives of people who benefit from them. This includes veterans and Medicare recipients. People in rural areas have also found telehealth services helpful as it is the most expedient way for them to get any medical help they need. 

However, its benefits have been marred by attempts to defraud the federal government of millions of dollars, according to Lawsuit Legal

Detecting fraud in telehealth programs

Unfortunately, this type of fraud is only detected from within the system as patients are unaware of what claims service providers make. Uncovering fraud cases and acting on them often comes after a whistleblower comes forward with valuable information and evidence. Authorities require more than mere speculation, so insiders must have ironclad proof of fraudulent activities.

The False Claims Act

Also known as the Lincoln Law, this legislation makes persons and companies who defraud governmental programs liable for their actions. The False Claims Act is the foundation upon which most cases of fraud against the government are premised. Under the False Claims Act’s terms, people who report telehealth fraud may be eligible for a reward that comes from any funds recovered after a case resolution. 

When reporting telehealth program fraud, you need to file a complaint under seal. The complaint is served on the government but not a defendant. When serving said complaint on the government, it must be accompanied by a document detailing the complaint’s factual basis. This document does not need to be filed in court to retain its confidentiality.

Nevertheless, becoming a whistleblower, also known as a relator, has several pitfalls. Despite guaranteed protection, many of these brave individuals have faced victimization, dangerous threats, constructive dismissal, and trouble finding new employment. 

These daunting risks might be a deterrent, but they have not stopped several people from doing the honorable thing and reporting fraud in telehealth programs. According to the False Claims Act’s provisions, relators can also recover double damages and attorney fees for any acts of retaliation by defendants. 

Recent activity

In early October 2020, the Office of the Inspector General (OIG) for America’s Department of Health and Human Services revealed details of a nationwide telehealth fraud takedown that happened in September. 

Among issues investigated were allegations that unnecessary and expensive dietary supplements were pushed on patients and that medication and other drugs were prescribed without a medical examination.

According to its estimates, there were more than $4.5 billion in losses in telemedicine alone. More than 250 medical professionals lost their federal healthcare billing privileges and over 300 defendants in more than 50 judicial districts facing charges. The OIG has made it abundantly clear that its investigation is by no means over and expects to lay further charges. 

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