Is Telemedicine Fraud in our Future?

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A bipartisan group of members of the U.S. House of Representatives introduced a bill to expand Medicare coverage of telehealth services this month. Telemedicine is expected to be the wave of the future, with the growth in home health technologies ramping up globally from 14.3 million in 2014 to 78.5 million in 2020 according to Tractica, a digital health advisory service. However, if there aren’t adequate checks and balances in the system to prevent fraud, the costs to the system could easily overwhelm any cost savings and efficiency benefits to the new method of treating patients.

Medicare currently pays for telehealth services provided by certain practitioners to individuals in certain rural areas or counties outside of a Metropolitan Statistical Area. The Medicare Telehealth Parity Act of 2015 would expand the list of eligible providers and removes geographic barriers. The bill would move the system to parity between telehealth and in-person services in three phases.

If Medicare isn’t careful, this could make committing health care fraud easier for doctors that want to game the system. How much easier would it be for doctors to claims reimbursement for services rendered if they don’t even have to have patients come into the office?

The U.S. loses billions every year to Medicare fraud already. In 2012, an FBI report estimated the amount lost at between 3 and 10 percent of all health care expenditures. Every year, the U.S. recovers a couple billion in fraudulent payments thanks to whistleblowers, their attorneys, the Department of Justice and the False Claims Act. But that’s still a drop in the bucket compared to the amount lost.

On the other hand, the recording of the telecommunication sessions could permit better review of the bills provided by health care providers. The problem is simply one of scale. There may not be a way for the government to review the sessions from every provider for fraud. Ultimately, the question is whether more providers will try to take advantage of the new system and how many will slip through the cracks.

Telemedicine is coming. There are a lot of initiatives that advance the ball on it. The 21st Century Cures Act just passed the House last week. But the version of the bill that passed only calls for Medicare to study whether care may be improved by expanding telehealth services and does not call for the expanded reimbursement of services rendered through telemedicine. Another potential bill introduced in previous sessions, the Telehealth Advancement Act, would extend Medicare coverage in remote areas and strengthen the broadband communication infrastructure there to allow the services to take place.

We should figure out how to prevent the fraud that plagues the current system from expanding to include it as well. Otherwise, we will need more whistleblowers.

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