Fighting Fraud
By Better Business Bureau Serving Greater Cleveland
During the beginning of the COVID-19 pandemic, the federal government and private insurance providers eased requirements for telehealth providers so consumers could access medical care safely and remotely. As a result, spending on telehealthcare exploded from $306 million in 2019 to $3.7 billion in 2020 among Medicare users alone. Similar trends were seen in the private healthcare industry. Now that pandemic fears are waning, private insurers, consumers, and the federal government are starting to take a closer look at charges from telehealth providers.
Last year, the Department of Justice charged (DOJ) 36 individuals for committing $1.2 billion in healthcare fraud, which included bogus telehealth invoicing. More recently in June, the DOJ charged 11 more defendants in unrelated cases with $2 billion in false healthcare fraud schemes. With such large-scale fraud cases being brought to trial, this prompted the Office of the Inspector General of the Department of Health and Human Services (HHS) to publish a report alerting the public about widespread telehealth fraud.
Telehealth fraud typically preys upon Medicare beneficiaries and takes the form of upcoding, misrepresenting services, billing for services not rendered, and kickbacks. However, problems with telehealth services are not just limited to seniors. Consumers with private insurance can also encounter similar issues with telehealth providers. For example, earlier this year, Better Business BureauⓇ (BBBⓇ) warned consumers about a Denton, Texas-based telehealth provider named Doctor Alexa. Consumers across 19 states submitted complaints to BBB alleging they booked a virtual medical appointment and paid a fee but then were never seen by a practitioner. Other times, patients said prescriptions from the doctor were never sent to the consumer’s pharmacy.
Telehealth has its risks as well as its benefits, so how can consumers protect themselves from bad actors? BBB Serving Greater Cleveland is recommending the following tips for consumers:
- Start With Trust – Check out a potential healthcare provider’s profile on BBB.org. Read other customer reviews and complaints to see if they have encountered problems with telehealth services.
- Check With Your Insurance Provider or Doctor – Ask your insurance provider or doctor for a list of approved telehealth practitioners. Some insurance companies have a mobile app or website interface to conduct virtual appointments. Medicare and Medicaid recipients can visit Medicare.gov and Medicaid.gov, respectively, to learn more about telehealth.
- Don’t Respond to Unsolicited Healthcare Communications – Many providers who are conducting unsolicited canvasing regarding free healthcare products or services are engaging in fraud. Typically these take the form of phone calls or direct mail pieces that advertise durable medical equipment (DME) like braces or genetic tests to find conditions like cancer. Items like these may be medically unnecessary for consumers but insurance may reimburse providers. Additionally, consumers should not provide any personal health history to these types of businesses.
- Keep Antivirus Software Up-to-Date – Consumers should keep antivirus software up-to-date on any device they use to connect with a telehealth professional. Additionally, consumers can also ask their provider if their platform is HIPAA compliant and if they are registered with the state.
- Review Statements and Pay With a Credit Card – Consumers should review invoices and statements to make sure their appointments are not misclassified or misrepresented. If consumers spot an issue, they can dispute charges with their credit card if telehealth services were misrepresented or not rendered.
Consumers can visit the Health Resources and Services Administration (HRSA)’s website on telehealth at https://telehealth.hhs.gov/. The HRSA is an agency of the U.S. Department of Health and Human Services. Consumers suspecting Medicare fraud should file a report with the Office of the Inspector General in the Department of Health and Human Services
Victim of a telehealth scam? Please help others avoid the same problem by reporting your experience on the BBB Scam Tracker. Have additional questions? Reach out to your BBB at 216.241.7678 or [email protected].
