Federates investigating rising telehealth charges


With telehealth restrictions during the COVID-19 pandemic in an effort to limit potential exposure to the virus, virtual assistance has become more frequent and the U.S. Department of Health and Human Services (HHS) is monitoring its use. undue.

In the face of the public health crisis, HHS moved quickly to expand the number of Medicare patients who could receive primary telehealth care. From February to April 2020, telehealth for these visits went from 0.1% to 43.5% and remained high even after resuming face-to-face visits in May.

A similar increase was seen by private insurers. “Before the pandemic, 15% of our outpatient care was done by phone or video. Over the past year, this has grown to a maximum of 80% and remains close to 48% after the most increases. recent, ”says Lisa Caplan, senior vice president of technology services at Kaiser Permanente.

A Medicare data pattern has already caught the attention of the Office of the Inspector General. According to a preliminary analysis presented at a briefing in Congress, from early March to late July 2020, clinicians billed Medicare telehealth visits at higher levels of complexity than face-to-face ones. For new patients, 22% of telehealth visits were billed at the highest level of complexity, compared with 16% of face-to-face visits.

That doesn’t necessarily mean there is widespread fraud, says Chris Schrank, deputy inspector general of investigations. There could be legitimate reasons for telehealth visits to be more complex; it may be more complicated and time consuming, in general, to make a medical appointment practically.

But this will be closely monitored. “We try to understand a lot of the problems that can occur,” Schrank says.

Telehealth is sometimes the source of fraud schemes, as telemarketing is used to set up fake visits to virtual doctors for patients, which can lead to unnecessary genetic testing or ordering medical devices. In these cases, scammers rarely bill for telehealth visits, so this is not a telehealth technical fraud, but the visits are used as cover to place orders and bill for unnecessary services.

In recent years, there has been several major investigations into this type of fraud. In September 2020, an investigation called Operation Rubber Seal led to the highest execution of the Department of Justice’s health fraud, which involved more than $ 6 billion in fraudulent claims, of which $ 4.5 billion was related to the telemedicine.

“It definitely offers people who are already involved in fraud more options,” says Matthew Sitton, a health attorney for Butler Snow, a law firm in Jackson, Mississippi. “We could see more sophisticated schemes over time trying to use telehealth to give them more legitimacy.”

Fake doctor visits, unnecessary tests

But despite the risk of fraud, the expansion of telehealth is likely to continue. It has proven to be very popular among patients, says Caplan. “The data show that our patients are adopting the choice and comfort that telehealth provides,” he says.

A recent survey showed that 89% of Kaiser Permanente members who completed a video visit were interested in a future video visit, and 87% said the video visit was more convenient than other methods of care.

Continuity of care, which is known to improve health outcomes, is significantly better with telehealth than with face-to-face visits, says Shira Hollander, senior associate director of policy development for the American Hospital Association.

“The rise in telehealth radically changed that equation. Missed or canceled appointments dropped significantly,” he reports. “So you can stay connected with your provider without having to give up something else in your life that is just as necessary.” The expansion of telecare has also improved access to health care for people who do not have primary care physicians. “It can get people out of the woodwork,” he explains.

The expansion of telecare under Medicare was made possible by emergency legislation that waived many of the restrictions. Previously, patients in rural areas could chat virtually with a specialist or doctor located elsewhere, but only from a clinic or doctor’s office.

Currently, significant changes allow people from outside rural areas to access telehealth, audio-only visits, and telehealth visits from home, Hollander says.

“We would like many of the changes to become permanent or extended” once the public health emergency is over, he says. The American Hospital Association is among the organizations asking Congress to pass laws that maintain the eased restrictions.

The Office of the Inspector General recognizes that telehealth can improve efficiency, comfort and access to health care, and health care teams have been given additional flexibility to provide it during the pandemic, he says. Schrank.

The agency will continue to monitor telehealth fraud with sophisticated data analysis systems, but Schrank urges patients and healthcare providers to report possible problems.

“Our best information comes from those involved in the healthcare system every day,” he says. “This real-time information is critical.”

Brian Owens is a freelance science journalist who has submitted his candidacy Nature, New scientist and the Lancet. He won a national magazine award for best news for an article in the Journal of the Canadian Medical Association.

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