The Do's and Don'ts of Telemedicine.

A recent fraud bust totaling over $1 Billion involving telemedicine and durable medical equipment (DME) companies shows just how effectively compliance enforcement is evolving alongside healthcare. The effort resulted in charges against 24 defendants, including the CEOs, COOs, and others associated with five telemedicine companies, the owners of dozens of durable medical equipment (DME) companies and three licensed medical professionals, for their alleged participation in the healthcare fraud schemes.

$1 Billion is massive, so you might be thinking there’s no way something that large could happen at your organization. But not all telemedicine enforcement is large scale. Small physician practices have also experienced telemedicine enforcement. For example, a psychiatrist, Dr. Anton Fry, from Danbury, Connecticut, recently agreed to pay $36,704 to settle allegations of false claims involving telemedicine services. The government alleged (based initially on a whistleblower who was a former patient) that Dr. Fry submitted improper claims to Medicare for psychiatric services that were provided over the phone to certain Medicare beneficiaries, instead of by meeting with the beneficiaries in the office and treating them in person.

As more patients and providers turn to telemedicine, we can expect to see a lot more enforcement actions. Now is the time to get acquainted with the rules and regulations surrounding this new technology. Medicare regulations represent a national payor and that’s why it’s so important to have a thorough understanding of the Medicare system. But as compliance professionals, we must also prepare for the variations that can come in the rules for telemedicine from state to state. This is especially true for Medicaid. Similarly, each commercial payor may have their own policy on telemedicine so it’s crucial to remember to examine your major commercial payor policies.

Avoid telemedicine pitfalls by downloading this free eBrief, The Guide to Understanding Telemedicine Rules and Regulations, and learn how to:

• Stay Ahead of Telemedicine Rules and Regulations for Medicare
• Protect Your Organization from Terrifying Enforcement Actions
• Navigate the Complexity of Billing and Payment Policies