Teleheath, Fraud and Complexity: Considerations for Policymakers
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Introduction
The COVID-19 pandemic drastically shifted how Americans accessed health care. Telehealth services became a main source of medical care, and as such, lawmakers, agencies and political leaders rushed to ensure that accessing telehealth was relatively easy, with as few regulatory hurdles as possible. Now, as lawmakers grapple with which of these temporary changes to make permanent for the new telehealth landscape, some are concerned about the potential for fraud in telehealth.
This is understandable; in late 2020, as another wave of COVID-19 hit the United States, the U.S. Department of Justice charged over 80 medical professionals with nearly $4.5 billion in telehealth-related fraud. The charges allege that providers made fraudulent insurance claims for, among other things, diagnostics after no or little audio interaction with patients and medical equipment charges. However, as the Alliance for Connected Care notes, these charges were in relation to violations made prior to the changes in federal telehealth restrictions that the pandemic brought.
Advocates for telehealth maintain that the use of video consultations and audio-only phone calls can greatly contribute to greater health care access in the states, as long as proper procedures are in place to prevent fraud, reduce uncertainty and complexity, and ensure equitable access to these services. And while telehealth fraud is not to be dismissed, it is reasonable to think that any fraudulent activity during the surge in telehealth use due to the pandemic may have ultimately been short-term fraud opportunities rather than an opening of floodgates for systemic fraud going forward. Here, we suggest policy considerations for these issues…
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