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July 16, 2020

Federal Government Steps Up Investigations to Expose Fraud as Telemedicine Expands

As telemedicine expands its essential role in the post-COVID-19 healthcare system, the federal government has increased its efforts to ensure that fraud and kickbacks do not interfere with legitimate patient referrals for telehealth services. In March, the HHS OIG lifted some restrictions on telemedicine to make healthcare more accessible as the country grappled with the effects of COVID-19. Among the restrictions that were lifted, telemedicine providers can reduce or waive patient deductibles and copayments for telehealth services paid for by federal healthcare programs, a move that would otherwise be considered a kickback and therefore illegal under the Anti-Kickback Statute.

As a result of the increased telemedicine flexibility, the OIG has increased its efforts to tackle fraud in telemedicine through “Operation Brace Yourself” and “Operation Double Helix,” two operations designed to ensure that patient referrals are based on sound medical advice and not financial greed. An inter-agency coalition, which includes HHS OIG and the DOJ, has ramped up efforts to investigate claims of potential telemedicine fraud. On July 9, the U.S. Attorney for the Southern District of Georgia reported cracking a $60 million telemedicine scheme. This new telemedicine prosecution is only the latest in more than $480 million of alleged fraud cases by the U.S. Attorney’s Office. Telemedicine providers should thoroughly evaluate financial arrangements with referral providers to ensure they remain compliant with current laws as the legal landscape continues to shift.

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