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Telemedicine Facing Increased Government Scrutiny

Posted in Fraud and Abuse, Hospitals and Institutions, Legislation and Public Policy, Medicare and Medicaid, Reimbursement Matters

An April 20 article in Bloomberg Law’s Health Law & Life Sciences News, “Telemedicine Facing Increased Government Scrutiny,” discussed the increasing scrutiny of telemedicine services by government agencies as questions regarding fraud, waste, and abuse increase. Day Pitney’s Eric Fader was quoted in the article.A recent report by the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) uncovered numerous improper telemedicine claims, including some in which Medicare patients received services at ineligible locations and others that were billed by ineligible providers.

Eric told Bloomberg Law that fast-growing healthcare sectors like telemedicine are often particularly vulnerable to abuse, as well as honest mistakes as provider education and oversight lag behind increasing utilization. “Telehealth is a classic example because the rules have been in flux, education and training of practitioners has been lacking, and [the Centers for Medicare & Medicaid Services (CMS)] apparently hasn’t yet put telehealth claims on its radar screen for oversight,” Eric said.

One problem for telemedicine, Eric observed, is that the different arms of the HHS aren’t coordinating with one another. Although the HHS’s Health Resources and Services Administration’s Medicare Telehealth Payment Eligibility Analyzer allows providers to check whether an originating site is eligible for Medicare reimbursement, in most of the claims that the OIG deemed improper, the patient was not treated at such a site. However, since provider claim forms don’t require that information, the CMS must take the provider’s word that treatment was provided at an eligible site.

“I’m sure some practitioners are simply confused, while others are taking advantage of the lack of oversight and submitting claims they know shouldn’t be reimbursed,” Eric said. The volume of telemedicine claims will only be increasing, he added, and if the CMS doesn’t get a handle on the problem the dollars lost to fraud will increase as well. 

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