It is no secret that telemedicine now plays a big part of our lives. As a healthcare ethics speaker, healthcare ethics consultant and book author I have long warned against seemingly perfect technologies being overtaken by fraud. It took but a few years and a pandemic to turn this diagnostic solution into a snake pit of fraud.
What has happened
According to insurance industry data, supplied by Verisk, “Telemedicine use in the US was eightfold higher in Q4 2021 than Q4 2019, the last full pre-pandemic quarter.” Worldwide data shows (Precedence Research), “The global telehealth industry could swell to be worth $224.8 billion by 2030.”
As was reported by business writer Jen Frost (November 28, 2022) for Insurance Business:
“It was under pandemic disruption that use soared – at its peak, telemedicine use in the US in Q2 2020 was up 21 times (or 2,100%) on Q4 2019…healthcare providers looked for ways to serve and assess people without coming into physical contact.”
However simultaneous to the growth, Frost wrote:
“In the US, where a large private health industry can make for an attractive arena for scammers and fraudsters, insurers had concerns as society withdrew and the technology became more important.”
Said Matthew Smith director of the Coalition Against Insurance Fraud, “When the Coalition Against Insurance Fraud, a US group, held a COVID-19 webinar with a large telehealth component on March 31, 2020, more than 3,000 people tuned in…it turned out to be the largest anti-fraud gathering ever, probably in world history.”
As a healthcare ethics speaker, healthcare ethics consultant and book author I could see the handwriting on the wall. The technology went from low usage in 2019 to an exponential increase by 2020. When the rise is that dramatic there is an automatic lack of oversite and compliance.
Listen to this
As reported by Insurance Business, based on data from the Coalition of Insurance Fraud, “US telemedicine fraud could be costing $25 billion to $35 billion a year.”
I was not at all surprised to read that, “The highest rate of US telehealth visits are among Medicaid users, at 29.3%, Medicare users, at 27.4%, people of colour, at 26.8%, and those earning less than $25,000 a year, at about 26%.”
Healthcare providers have sadly, always taken advantage of the poor in our society. It blossomed with telehealth where unnecessary visits skyrocketed. Right now, Medicare is defrauded nearly $60 billion a year. This is outrageous as the need to pocket extra cash seems to have replaced ethical behavior and decency.
In an industry where ethical education and reinforcement of that teaching is tragically lacking, there are often excuses made for over-billings and improper coding. And while I am willing to concede that coding errors can happen, it is difficult to overlook the industry findings as again reported by the Coalition of Insurance Fraud.
At least 4 types
The “Coalition” determined four types of telemedicine fraud:
- Unlicensed medical providers –This usually occurs in regions of the U.S. where the medical providers are not licensed to operate. It was an on-screen free-for-all.
- Billing for services not rendered – This is out and out cheating; simply billing for non-existent sessions.
- Upcoding – This is taking a simple exam or evaluation for example, a service that should have taken a 15-minute block of time to carry out, and charging for an hour.
- Improper patient sharing – This scam occurs when a patient is unnecessarily shuttled from specialist to specialist.
The U.S. Department of Justice has already uncovered billions of dollars of such fraud including illegal bribery and kickbacks, with charges running all of the way up the ladder to corporate CEOs of telehealth companies and the healthcare providers they employed.
It is difficult to imagine men and women who have gone through medical and nursing schools to be perpetuating these frauds. Then again, my imagination as an ethical keynote speaker in the healthcare industry is often astounded by needy providers who are fueled by their own rationalizations.
Telehealth fraud will worsen unless ethical expectations are in place to stop it.
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