Rollbacks on Telehealth Regulations Lead to Concerns Over Billing Fraud

The Centers for Medicare and Medicaid Services (CMS) unveiled a plan to promote widespread use of telehealth, which was previously limited to rural areas, by temporarily lifting a variety of federal restrictions on the use of the service during the coronavirus pandemic. CMS has approved dozens of new billing codes to allow medical professionals to bill for these services and has allowed telemedicine providers to waive deductibles and copayments during the pandemic. Additionally, the CARES (Coronavirus Aid, Relief, and Economic Security) Act awards $200 million through the Federal Communications Commission to medical groups to fund technology and network installations. These actions have raised concerns about a potential wave of billing fraud tied to telehealth, as well as a risk to patient safety.

“There are unscrupulous providers out there, and they have much greater reach with telehealth,” said Michael Cohen, DHSc, JD, PA-C, of the Office of Inspector General for the U.S. Department of Health and Human Services, which investigates health-care fraud. Dr. Cohen warns that anti-fraud protections have been relaxed under the new emergency policies, and there may be industry pressure on CMS to make some of these changes permanent.

Officials worry about Medicare fraud in the form of telemedicine companies using patients’ private information in marketing ploys. In September 2019, 35 people were charged in connection with a telemedicine scheme that allegedly defrauded the Medicare program of more than $2.1 billion. Fraud cases linked directly to COVID-19 have already been reported, including instances of patient account information being used to bill for fake testing or “coronavirus emergency kits” consisting of gloves and hand sanitizer.

The Alliance for Connected Care (ACC), a telehealth lobbying group, hopes CMS will make some of the regulatory changes permanent to assure the industry’s survival once the lockdown eases, arguing it is no more prone to fraud than any other sector of health care. ACC has spent more than $1 million on lobbying for some of these changes since 2016, according to the Center for Responsive Politics. As the shutdown continues, the coronavirus pandemic has brought telehealth to the forefront of the medical industry more rapidly than years of lobbying in Washington.

Source: Kaiser Health News, April 22, 2020.