Until the pandemic, the rules for government reimbursement of healthcare visits were pretty clear cut. A beneficiary under a government sponsored healthcare plan (the patient) went to a provider (the doctor) who subsequently billed the government for the patient’s care. These programs include Medicare, Medicaid, the Veterans Service Administration, TRICARE and Indian Health Services. These government programs resisted reimbursing for patient care that did not arise out of a face to face visit with a provider except in rare instance. Then came the COVID pandemic and public health guidance urging people to stay home and avoid even routine doctor visits. Of course, for most Americans – and especially for the sick and elderly – visits to the doctor are critical to monitor ongoing health conditions unrelated to COVID-19. To meet their healthcare needs while they stayed safe at home the government pivoted quickly to find ways to provide healthcare for these beneficiaries even when they weren’t going in to a doctor’s office. A massive shift to telehealth was born.
What is Telehealth?
The United States Department of Health and Human Services defines telehealth as “the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, and public health and health administration. Technologies include videoconferencing, the internet, store- and-forward imaging, streaming media, and landline and wireless communications.”
DOJ Prioritizes Cracking Down on Telehealth Fraud
Unfortunately, the government’s decision to relax the requirements for face-to face visits and to begin reimbursing for more telehealth services creates new opportunities for fraud. That is why DOJ has made clear that it will be evaluating cases brought under the False Claims Act alleging telehealth fraud. DOJ’s priorities in the COVID era follow enforcement actions it took before the pandemic, including alleged violations of the anti-Kickback Statute and unlawful marketing of durable medical equipment involving telehealth. Other telehealth schemes could include doctors billing for patients they don’t actually see, kickbacks to secure more patients since the geographic range a provider may service is greatly expanded, and manipulations of electronic medical records.
With billions of dollars in taxpayer money for these important services at issue the risk of fraud is high and the need for whistleblowers to expose the schemes is critical. If you have information about a fraud involving telehealth, please call us or fill out the form below for a free and confidential consultation.
Who we are
Keller Grover LLP
Whistleblower cases require lawyers litigating them to prove a fraud while protecting their client who typically learns of the fraud at work. While many law firms have experience dealing with fraud cases or employment issues, few are experienced enough to handle both issues together. The lawyers at Keller Grover have over 30 years of experience litigating both fraud and employment matters, and more than a decade of experience litigating cases involving violations of the federal False Claims Act and the state equivalents. We have secured groundbreaking decisions interpreting these laws on numerous issues relevant to all whistleblowers. We are also regularly featured speakers on all aspects of our law practice to audiences including other qui tam lawyers and government lawyers. We have secured judgments totaling tens of millions in recovery to taxpayers. This rare combination makes Keller Grover uniquely qualified to represent whistleblowers.
Contact Us
If you have information about a fraud involving telehealth, Please call us or fill out the form below for a free and confidential consultation.