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The COVID-19 pandemic has accelerated countless big-picture trends across the world. One important area that showed significant change is the telemedicine universe. To illustrate the explosive growth in telemedicine visits, consider that, by April 2020, around 44 percent of doctor’s visits by Medicare recipients were conducted virtually. Just two months earlier, that figure hovered around 0.1 percent.
In anticipation of the pandemic’s effects on medical care, restrictions were loosened by the Centers for Medicare and Medicaid (CMS) in order to meet patients’ needs. At the same time, the Office of Inspector General within the Department of Health and Human Services was conducting an investigation that resulted in one of the largest health care fraud takedowns ever. The primary target? Those who used telemedicine to defraud Medicare out of several billion dollars.
The Scheme
The takedown — officially referred to by HHS as the “2020 National Health Care Fraud Takedown” — largely focused on 86 defendants whose ultimate goal was to provide Medicare patients with unnecessary care. That unnecessary care in the form of worthless durable medical equipment, genetic testing, and medication. The fraudsters saw an opportunity within telemedicine to claim that the patients received virtual visits that never occurred. Other times, the patients were prescribed the unnecessary care after having had only a brief telephone interaction.
It was alleged that Telemedicine executives paid doctors, nurses, and other medical personnel to order the unnecessary care. After the care was rendered, the executives were then paid by providers — a textbook case of a kickback scheme.
What Does This Say About Future Enforcement?
Various federal and state agencies had already begun paying closer attention to telemedicine fraud prior to COVID-19. It is reasonable to assume that HHS will continue to pursue kickback schemes perpetrated through virtual health visits. Additionally, up-coding and other common methods of Medicare fraud will remain in the forefront of HHS investigations regarding telemedicine.
Even though CMS relaxed a handful of restrictions, telemedicine providers need to make sure they are in compliance with every applicable regulation. A significant part of the recent takedown had to do with questionable marketing tactics; if you are a telemedicine provider, it’s worth it to take a second or third glance at your own strategies and tactics.
Weisberg Kainen Mark Can Provide a World-Class Defense
While many methods of Medicare fraud have been around for decades, the advent of telemedicine has made it easier to execute a handful of those methods in addition to creating the opportunity for new ones. At any rate, you need a skilled white-collar criminal defense firm that has a track record of success. Our firm is well-equipped to handle any number of white-collar charges; call us at 305-374-5544 to set up a consultation with our team.
Weisberg Kainen Mark, PL
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