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Telemedicine Facing Increased Government Scrutiny

Publisher: Bloomberg Law’s Health Law & Life Sciences News
April 20, 2018

Eric Fader was quoted in an article, “Telemedicine Facing Increased Government Scrutiny,” published in Bloomberg Law’s Health Law & Life Sciences News. The article discusses the increasing scrutiny of telemedicine services by government agencies as questions regarding fraud, waste, and abuse increase. 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. Fader 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,” Fader said.

One problem for telemedicine, he 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,” Fader 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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