Healthcare Fraud Prevention Partnership Releases White Paper on Telehealth-Related Fraud, Waste, and Abuse

BALTIMORE, May 10, 2023 /PRNewswire/ -- Telehealth services enable providers to offer care to patients by leveraging electronic and telecommunication technologies, such as computers, tablets, or phones, for patient-provider information exchange and remote monitoring. Providers can remotely make diagnoses, supervise care, provide health coaching or education, and consult with patients who face challenges accessing healthcare. Telehealth services are an essential method of healthcare delivery due to the simplified and prompt access patients have to their providers.

Prior to March 2020, policies regarding telehealth services varied among healthcare payers. Telehealth was generally used to support patients in rural areas or locations designated as a health professional shortage area. When traditional in-person office visits were no longer feasible due to the COVID-19 Public Health Emergency (PHE), telehealth services were broadly adopted, regardless of region. Federal and state governments swiftly introduced new flexibilities in policies and regulations to enable the broader use of telehealth services to ensure the healthcare system could remain responsive to patient and provider needs.

While expanded use of telehealth services improved the overall adaptability of U.S. healthcare, bad actors have taken advantage of its rapid growth and acceptance to both broaden the reach of existing fraud schemes and create novel ones. Federal, state, and local agencies took progressive approaches to combat related fraud, waste, and abuse schemes in response to the accelerated use and flexibilities in telehealth and subsequent exploitation. In support of these efforts, the Healthcare Fraud Prevention Partnership (HFPP) has released its latest white paper, "Exploring Fraud, Waste, and Abuse Within Telehealth", developed in collaboration with researchers from the Stanford University School of Medicine.

The HFPP is a voluntary, public-private partnership between the federal government, state and local agencies, law enforcement, private health insurance plans, and healthcare anti-fraud associations. The Partnership aims to identify and reduce fraud, waste, and abuse across the healthcare sector through collaboration, data and information sharing, and cross-payer research studies. Given the HFPP's broad membership encompassing a variety of stakeholders involved in detecting healthcare fraud, waste, and abuse, it is uniquely positioned to examine emerging trends – such as those observed within telehealth – and develop key recommendations and strategies to address them.

Developed with direct insight from HFPP Partners, this resource provides background on the use of telehealth services prior to and during the COVID-19 PHE and identifies fraud schemes that take advantage of increased telehealth usage, including:

• Billing for medically unnecessary services or services that traditionally cannot be delivered via telehealth
• Upcoding to a higher level of service than rendered
• Utilizing unreasonable time-based codes
• Miscoding virtual COVID-19-related care to receive enhanced payments

In addition, HFPP Partners, industry experts, and researchers offer numerous strategies to help mitigate vulnerabilities related to telehealth services fraud, such as:

• Incorporating data analytics and machine learning to bolster detection efforts
• Increasing patient and provider awareness about fraud, waste, and abuse schemes
• Developing collaborative relationships among various types of healthcare organizations

To read the telehealth services white paper or for additional information about this new resource and the HFPP, please see:

• White Paper: Exploring Fraud, Waste, and Abuse Within Telehealth
• Information Sheet
• HFPP Website

If you have questions or are interested in joining the HFPP, please contact the HFPP's Trusted Third Party at [email protected], or visit the HFPP website at cms.gov/hfpp.

Media Contact:
Sean Beardsley
[email protected] 
1.267.572.0260

SOURCE Healthcare Fraud Prevention Partnership (HFPP)