Telehealth medicine was a Godsend during the peak of the COVID-19 pandemic that forced people to hunker down in their homes for extended periods. It became more common for general practitioners and medical centers to tell you to stay at home than to make an office appointment if you weren’t feeling well.
Generally speaking, if you were admitted to a hospital for severe Covid symptoms, chances are you weren’t going to walk back out alive. Only now have researchers discovered that ventilators might have actually been frying patient’s viral infected lungs rather than healing them.
Whatever the case, telehealth is here to stay, and for good reason. It provides a viable medical alternative to those who either refuse to be seen in a clinical atmosphere or who can’t get there because they live in a remote region or lack the resources and transportation to get them there.
However, telehealth is not without its problems, including fraud which can occur in the form of insurance companies who submit duplicate claims, or even patients who attempt to be prescribed heavy-duty medications which they then sell on the black market.
Telehealth encounters often involve the transmission of sensitive medical information over digital channels.
While advancements in encryption technology aim to secure these interactions, the risk of data breaches and unauthorized access remains. With the promise of convenience and accessibility, telehealth has undoubtedly made significant strides in improving patient care. However, as we embrace this digital transformation in healthcare, it is crucial to shine a light on the potential risks that may be lurking beneath the surface.
Patients may find themselves questioning the confidentiality of their health records and the security measures in place to safeguard their personal information.
Says healthcare fraud lawyer, Nicholson & Easton, LLP, if you’re a medical professional who provides telehealth medicine and you’ve experienced fraud, you have the right to an attorney who will represent you in a court of law. You will need a lawyer who possesses extensive experience when it comes to handling a broad range of healthcare abuse and fraud, and who can provide you with a defense that most law firms and attorneys do not possess.
That said, what are some of the risks associated with telehealth medicine? Can the risks be mitigated? According to a recent report by Telehealth.org, while telehealth comes with lots of perks, such as the ability for the healthcare industry to stay open during global emergencies such as the COVID-19 pandemic which began in 2020 and lasted more than two years, it is also said to be ripe for risk and abuse.
Due to the U.S. federal government’s history of aggressive investigation of medical abuse and fraud, healthcare organizations that do not remain in compliance with telehealth regulations and rules can place themselves in significant jeopardy. Their practices can face expensive litigation and be slapped with costly fines.
It’s important to note that telehealth did not arise during the recent pandemic. It predates the pandemic by decades despite its newfound surge in popularity.
During the first six months of 2020, close to one-third of all medical appointments were conducted via telehealth. This represented a massive increase from one year prior. Telehealth services are said to have resonated even in the post-pandemic world with patients largely reporting their newfound satisfaction with the efficiency in the medical system.
That said, telehealth had also been the target of society’s bad element which means the federal government is keeping close tabs on suspected telehealth abuse and fraud cases.
Risks Associated with Telehealth Medical Services
Recently the Department of Justice or the DOJ announced their largest healthcare fraud bust in history. This amounted to more than $6 billion in suspected fraud loses. A whopping $4.5 billion of this was tied directly to telehealth.
Government officials have recorded specific instances of telehealth executives who provided kickbacks to providers for orders of durable medical equipment, or DME, that were determined to be unnecessary. They also committed fraud when it came to the distribution of medications, plus diagnostic and genetic testing services.
Operation Rubber Stamp
Says Telehealth.org, the DOJ’s Operation Rubber Stamp uncovered a telemedicine scheme that had robbed Medicare of more than $1.5 billion in physical medical equipment. This does not include telehealth services fraud. This resulted in more than 250 providers having their Medicare reimbursements revoked.
Telehealth might be relatively new for many patients, but its history of risk, fraud, and abuse is not. Not long ago a $750 million telehealth fraud case was uncovered when a Florida telemedicine company owner was indicted for tax evasion, illegal kickbacks, and making fraudulent orders to medical suppliers via Medicare claims.
Prior to the Florida case being exposed, the DOJ is said to have charged more than 35 telehealth professionals including a number of professionals from a cancer genetic testing lab, with healthcare fraud. The result was approximately $2.1 billion in fraudulent Medicare claims that occurred between 2017 and 2019.
Mitigating the Risk of Telehealth Fraud Going Forward
Because of telehealth’s growing popularity over the past few years, DOJ and other federal investigators will be upping their game against the industry’s bad element, or so said the acting federal Inspector General, Chris Grim. He also highlighted new technologies, methods, and policies that have the potential to enhance patient convenience while improving overall healthcare via telemedicine. What’s more, it will be far more difficult for bad actors to commit fraud with these new systems.
Telehealth operates within a complex web of regulations and legal frameworks that vary across regions. Navigating these intricacies can be challenging for healthcare providers, potentially leading to legal issues if not handled appropriately. Ambiguities in licensure requirements and the scope of telehealth services can create uncertainties that need to be addressed.
While telehealth medicine holds immense promise in improving healthcare accessibility, it is crucial to acknowledge and address the associated risks.
Privacy concerns, technical glitches, limited physical examinations, the digital divide, and regulatory challenges are all facets that demand careful consideration. As we continue to embrace the era of telehealth, a proactive approach to mitigate these risks is essential to ensure the delivery of safe, effective, and equitable healthcare for all.
