As telemedicine expands, insurance fraud grows

With the strong support of regulators, including in New York, telemedicine has significantly expanded since the beginning of the COVID-19 pandemic. See, e.g., New York State Department of Health, Comprehensive Guidance Regarding Use of Telehealth Including Telephonic Services; Governor Hochul Announces $3 Million in New Grants To Expand Access to Telehealth across All New York Regions.

At the same time, the opportunities for fraud have increased. Unscrupulous international and domestic telemarketing call centers, staffing companies, marketers, brokers and practitioners, among other individuals and entities, have recognized the potential to line their pockets, and many have done so—and continue to do so.

Consider the charges brought several months ago against an orthopedic surgeon who was indicted in federal court in Brooklyn for what prosecutors characterized as a $10 million telemedicine health care fraud. According to the government, the surgeon purported to practice telemedicine with telemedicine companies that paid him $25 or $30 for each consultation he had with a Medicare or Medicare Part D beneficiary. Prosecutors alleged that the surgeon signed prescriptions and order forms for durable medical equipment (DME), including orthotic braces, that were not medically necessary. The government contended that the surgeon caused the submission of these claims based solely on a short telephone conversation for beneficiaries he had not physically examined and evaluated, and that were induced, in part, by the payments of bribes and kickbacks.