Telehealth changed where healthcare can happen. It also changed where healthcare fraud can happen.
The risk isn’t telehealth itself.
It’s the ability for bad actors to connect patients, , providers, prescriptions and claims across hundreds — or thousands — of miles with very little traditional interaction.
Federal enforcement continues to demonstrate how sophisticated these arrangements can become.
In one recent case, the owner of a telemedicine company pleaded guilty in a $46.2 million Medicare fraud conspiracy spanning more than six years.
And OIG continues to examine program safeguards surrounding virtual check-ins and e-visits.
That creates an important challenge for health plans:
A claim may look perfectly normal in isolation.
The pattern may only become visible when investigators connect the provider, patient, , referral source, geography, utilization and supporting documentation.
Digital healthcare requires digital detection.
But it still requires human investigation.
#Telehealth #HealthcareFraud #FWA #ProgramIntegrity #PaymentIntegrity #Medicare #SIU #HealthcarePayers
Source: U.S. Department of Justice
https://lnkd.in/espNhqyh
Source: HHS Office of Inspector General
https://lnkd.in/esytyBHa
