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Expert fears telemedicine fraud could cost $1 trillion

Billions in losses identified in 5 months
HHS-OIG Federal Agent
Posted at 7:13 AM, Aug 30, 2021

TAMPA, Fla. — The increased use of telemedicine during the COVID-19 pandemic has led to a rise in healthcare fraud committed against Medicare and Medicaid programs.

Billions of dollars of fraud have already been identified and one expert warns the number of losses could increase exponentially if safeguards aren’t quickly put into place nationwide.

When the coronavirus pandemic shut down America last year, Congress acted quickly to ease restrictions on telemedicine through the CARES Act. That allowed doctors to bill Medicare and Medicaid for seeing patients and providing services remotely for the first time. They were also allowed to charge for seeing patients in other states for the first time.

Largest amount of fraud ever charged

Plenty of people broke the rules.

“Today’s announcement marks the largest amount of fraud ever charged by the Department of Justice in a single national takedown operation,” announced Acting Assistant Attorney General Brian Rabbit at a Press Conference in September 2020.

Three hundred and forty-five suspects were indicted on felony health care fraud-related charges, including nine from the Tampa Bay region.

“The largest amount of fraud in the cases announced today, representing more than $4.5 billion, relates to telemedicine,” Rabbit said.

That was in just five months.

“Telehealth appointments shot up like a rocket during COVID,” said Haywood Talcove, CEO of Lexis Nexis Risk Solutions, Government Group.

He believes criminals have been using the stolen identities of both doctors and patients to bill for services never provided.

How Telehealth Fraud Takedown Went Down

Government is the easy target

“What COVID taught the transnational criminal groups is that government is the easy target,” Talcove said.

Talcove’s company provides advanced analytics and identification verification services to government agencies, banks, and businesses.

“Once you’re a doctor, and you’re approved for Medicaid, it is a license to bill. And the only thing that can constrain you is the auditing and other functions that the state has,” Talcove said.

Talcove said many states have outdated computer systems, which aren’t equipped to spot suspicious billing patterns. He said one recent case of telemedicine fraud involved a fake medical office, composed of eight fake doctors that billed over $90 million in one year, before suddenly disappearing.

Talcove believes some of the same criminals targeting Medicaid used similar methods to steal $250 billion from state unemployment insurance programs. That’s $800 for every man, woman, and child in the United States.

Last month, the I-Team reported how debit cards sent to unemployment insurance recipients from California turned up during a Tampa Police traffic stop. One of those cards was sent to a person who had been in prison for 15 years.

“They learn from each other on the Dark Web. They share. If you see it in one place, you’ll see it all across the country,” Talcove said.

Medicaid patient information at risk

“A lot of times, it is patient information that’s especially at risk,” said Attorney Matt Sitton, who recently wrote a brief about telemedicine fraud for the American Health Law Association.

That association is composed of attorneys who represent doctors, medical groups, and hospitals. Sitton worries widespread fraud could affect future benefits for patients and the overall financial health of hospital systems, which depend on government funding.

“I think a lot of states are hard-pressed for resources when you have so many other issues to deal with a lot of times. The last thing on the plate can be going after localized Medicaid fraud,” Sitton said.

“We are going to lose a trillion dollars”

The Florida Agency for Health Care Administration, which oversees Medicaid, sent the following statement:

The Agency diligently works to remain apprised of emerging fraud trends and the potential far-reaching impacts of the schemes. Balancing the program’s ability to have a broad array of services and service delivery options with inherent fraud risks and mitigation efforts requires diligence, communication and collaboration both internally and with external partners.

A spokesperson for Florida Attorney General Ashley Moody’s office, which prosecutes Medicaid fraud, urges Medicaid recipients who receive statements for services they didn’t receive to contact their office.

Talcove says it’s time for every state to act quickly before the problem gets out of hand.

“We don’t have five years to put together a new plan. We don’t even have five months. We are going to lose a trillion dollars,” Talcove said.

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