Adopting Telemedicine? Be Mindful of the Potential for Fraud—and Consequent Penalties

As happens often with advances in the way medicine is practiced—and billed for—telemedicine has now reached a level of acceptance sufficient for widespread fraud to become an issue. The U.S. Department of Justice has levied charges of fraud totaling more than $6 billion against 345 people in 51 federal districts, with $4.5 billion of that sum connected to telemedicine billing. It’s the DOJ’s biggest fraud roundup ever. Those charged in the telemedicine sweep 86 defendants, mainly executives, who would lean on physicians to prescribe medical devices, testing, or prescriptions that were not medically necessary after a brief virtual encounter with a patient. Government payers would then be billed. The Centers for Medicare & Medicaid Services says it will revoke billing privileges for 256 providers caught up in the telemedicine fraud. In a separate set of investigations, the DOJ has charged 24 individuals with a $1.5 billion scheme. The lesson is clear: Follow proper procedures for telemedicine as you would for any type of care, including refraining from trying to influence clinicians to disregard their instincts as to what constitutes appropriate care.