In July 2022, the Department of Justice (DOJ) announced criminal charges against 36 defendants for committing a variety of alleged schemes to defraud Medicare using telehealth. According to the DOJ, the alleged actions of the defendants led to $1.2 billion in medical fraud, with much of that coming from fraudulent telehealth claims for cardiovascular and cancer genetic testing and unnecessary durable medical equipment (DME).

Telehealth is the latest type of fraud to emerge in the healthcare industry. While telehealth made it possible for patients to receive healthcare during the pandemic, widespread use and lenient restrictions have made it a target for fraud and abuse. In this article, we discuss the different types of telehealth fraud we’re seeing in the healthcare industry.

Types of Fraudulent Telehealth Schemes

Telehealth fraud can take a variety of different forms, ranging from false claims from inaccurate billing or coding to complex kickback schemes. Here are some fraudulent schemes involving telehealth.

  • Billing Medicare for unnecessary durable medical equipment (DME)
  • False billing or coding for medical treatment and services
  • Kickbacks paid to doctors or others to get referrals for healthcare services or treatment in violation of the Anti-Kickback Statute
  • Unnecessary or excessive prescriptions, especially opioid prescriptions. Unnecessary or non-existent screening tests for cancer and other conditions

How to Report Telehealth Fraud: What You Can Do

If you suspect fraudulent telehealth schemes or have seen signs that indicate telehealth abuse, it’s important to gather as much information. The information you provide will help your legal team build a stronger case. Here are just a few items to consider when documenting data and information:

  • Names of important players: doctors, pharmaceutical representatives, lab facilities
  • Names of drugs or treatments being off-labeled, marketed, abused, or misused
  • Any websites, phone numbers, or cell phone data associated with the fraudulent activity
  • Copies of documents used to record and solicit information
  • Knowledge or evidence of false medicare claims
  • Nature of any kickbacks exchanged: how were the parties compensated
  • Knowledge of lead generation/targeting practices
  • Failure of medical facilities to uphold patient care

The signs of telehealth fraud are varied and sometimes tailored to fit specific drugs, treatments, or illegal goals. You can explore more examples of allegations and how to report fraud on our website. It’s essential to gather information carefully.

Become a Whistleblower

Whether you’re a telehealth patient, healthcare worker, or simply have information about healthcare providers attempting to defraud public funds, you may be eligible to become a whistleblower.

DJO is comprised of a highly experienced team of whistleblower experts, lawyers, and even former whistleblowers, who strive to deliver the highest monetary reward for brave individuals who have valuable information that can bring fraud to light.

If a whistleblower’s lawsuit is successful, the reward can be between 15% to 25% of the funds recovered. The False Claims Act also offers whistleblowers protection against job retaliation or wrongful termination.

If you have valuable information that can help expose fraud, we encourage you to speak to our experts. We will be there every step of the way to ensure you are safe and your information is confidential so you will have confidence knowing you’re doing the right thing. Contact us today.

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