The U.S. Department of Health and Human Services’ Office of Inspector General recognized telehealth’s potential while cautioning that steps must be taken to ensure virtual care will not be compromised by fraud. watchdog

OIG Principal Deputy Inspector General Christi A. Grimm wrote in a statement on Friday that the quick pivot to telemedicine amidst the COVID-19 pandemic makes oversight, transparency, accountability and program integrity all the more important.

“OIG is conducting significant oversight work assessing telehealth services during the public health emergency. Once complete, these reviews will provide objective findings and recommendations that can further inform policymakers and other stakeholders considering what telehealth flexibilities should be permanent,” wrote Grimm.

WHY IT MATTERS

Grimm noted that for most people, telehealth expansion is viewed positively, given its potential to increase access, decrease burdens and enable better care.

She pointed to recent rulemaking in which OIG recognized the promise that digital health technologies, including telemedicine, have for improving care coordination and health outcomes.

“Where telehealth and other remote access technologies were once a matter of convenience, the public health emergency made them a matter of safety for many beneficiaries,” wrote Grimm.

Advocates applauded the statement, saying they were ready to work with the agency to ensure telehealth services continue safe care.

“We must protect the taxpayer from healthcare fraud while ensuring Medicare beneficiaries maintain access to high-quality virtual care,” said American Telemedicine Association CEO Ann Mond Johnson.

Grimm in her statement also differentiated between telehealth fraud and “telefraud” schemes. Regarding the latter, the agency conducted investigations of fraud schemes that leveraged the reach of telemarketing schemes in combination with doctors conducting sham remote visits.

“In many cases, the criminals did not bill for the sham telehealth visit. Instead, the perpetrators billed fraudulently for other items or services, like durable medical equipment or genetic tests,” noted Grimm.

THE LARGER TREND

Concerns about fraud have weighed heavily on conversations around telehealth expansion, with members of Congress and advisory groups reiterating the importance of preserving the integrity of telemedicine programs.

Although Grimm didn’t mention it directly, her statement seemingly alluded to a recent case in which a Florida-based woman pleaded guilty to conspiracy to commit healthcare fraud and filing a false tax return.

In that case, the U.S. Department of Justice alleged that Kelly Wolfe and her conspirators submitted more than $400 million in illegal durable medical equipment claims to Medicare and the Civilian Health and Medical Program of the Department of Veterans, relying on the guise of “telemedicine” to explain the unusually high volume of claims.

ON THE RECORD

“As our work and the national conversation continues, OIG believes there is a shared goal: ensuring that telehealth delivers quality, convenient care for patients and is not compromised by fraud,” said Grimm.

“As we continue our COVID-19 oversight and enforcement work, we look forward to providing objective, independent information to stakeholders and policymakers,” she continued.

Source: HHS watchdog reiterates importance of preventing telemedicine fraud

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