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Analysis finds uptick in telehealth fraud enforcement


A survey put forward by the national healthcare, life science and workforce management law firm Epstein Becker Green found that telemental health services have increased in quantity this year – as have fraud-related enforcement actions at the state and federal levels.  

“These enforcement actions demonstrate that the telehealth industry should not only consider the law from a policy and operations perspective, but should also invest in a robust compliance infrastructure,” wrote report authors in the 2021 Telemental Health Laws Survey analysis.  


The report noted that more frequent fraud has driven law enforcement agencies to crack down on medical providers who are accused of abusing the system.  

For instance, it cited efforts this year from the U.S. Department of Justice to address $143 million in telehealth-related false billing and to target defendants for allegedly participating in various healthcare fraud schemes.   

It also pointed to actions taken by the Center for Program Integrity against more than 50 medical providers for alleged schemes relating to Centers for Medicare and Medicaid Services programs.  

“Also in September, the [Office of Inspector General] reported that more than 20 states noted fraud, waste, and abuse as a ‘concern’ specific to telehealth,” reads the report. “Furthermore, the OIG recognized that some states do not have the resources to protect healthcare organizations against fraudulent schemes.”  

The report authors also took a deep dive into telemental health developments across the country.  

“By the end of 2021, many states will have revoked temporary states of emergency that include telehealth policy adjustments,” they observed.   

They continued, “However, these states are activating more permanent laws to provide patients and providers the option to continue with telehealth services and increase patient engagement.”

Analysts highlighted several policy trends, including:  

  • Professional licenses, with many joining compacts that make it easier for healthcare professionals to practice in other states.
  • Prescription practices, such as allowing physicians to prescribe non-controlled substances remotely.
  • Patient privacy and confidentiality, aimed at ensuring patients’ privacy while using telecommunications with healthcare professionals.

“Now more than ever, legislators are under immense pressure to manage the flexibilities granted in response to the COVID-19 pandemic which increased patient access to telehealth services exponentially,” said Amy Lerman, a member of the firm in Epstein Becker Green’s Health Care and Life Sciences practice, in a statement accompanying the survey.  


Advocates and experts have raised concerns about the longevity of telehealth policies after the end of the COVID-19 public health emergency. Although – as the Epstein Becker Green report noted – many states have enacted their own telemedicine laws, groups have still urged Congress to take action on a federal level, particularly regarding Medicare.  

But the threat of fraud still looms large, too: “It’s important that these new policies that have this great potential to improve care aren’t compromised by fraud or abuse or misuse,” said HHS-OIG’s Andrew VanLandingham in an interview this summer with Healthcare IT News.  


“The continued emphasis on telehealth services has put a much greater focus on the potential for fraudulent behavior and the need for enforcement activity, and it’s vital to refine the current policies in order to ensure compliance and mitigate risk associated with the healthcare industry’s progress,” said Lerman in a statement.  

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

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