As telehealth services gain popularity, extending Medicare reimbursements for these digital consultations has received overwhelming bipartisan support, with the House passing legislation for extensions through 2024. However, Representative Lloyd Doggett voiced concerns about the potential for fraud within telehealth services, emphasizing the need for protective measures against fraudulent activities.
Despite the broad endorsement of telehealth for its convenience, apprehensions about it enabling fraud persist. Scammers, healthcare providers, and companies could exploit telehealth to conduct unnecessary medical procedures, prescribe unneeded medications, and bill Medicare inappropriately. Another potential issue is overutilization, where the ease of virtual consultations could lead to excessive, non-critical medical visits, escalating healthcare costs.
Congress is seeking more data on telehealth’s use during the pandemic but is pressed for time, as current telehealth flexibilities are linked to the duration of the COVID-19 public health emergency declared by the Department of Health and Human Services (HHS). With a lack of substantial evidence and HHS’s emergency status potentially expiring in October, there’s an urgency to address these issues.
While HHS’ inspector general has not found widespread overbilling under the new telehealth rules, concerns remain about kickback schemes and overprescription. The Department of Justice has made arrests related to schemes involving telemedicine companies and unnecessary medical services, though some argue these issues are not unique to telehealth.
The debate extends to whether ease of access to telehealth could prompt overprescription by companies, as highlighted by allegations against the digital health company Cerebral. The ease of telehealth services may also encourage overutilization, although studies show varied results on whether this leads to unnecessary medical care.
Discussions on implementing safeguards to prevent fraud in telehealth are ongoing, with no clear consensus. Some suggest requiring periodic in-person appointments, while others propose using artificial intelligence to detect fraud without hindering the growth of telehealth. As telehealth becomes a staple in healthcare delivery, ensuring its responsible and secure use remains a priority for lawmakers and health policy experts.
