On January 3, US Attorney Michael A. Bennett of the Western District of Kentucky announced that a telehealth company had agreed to pay $358,514 to resolve allegations that it improperly billed Medicare for telehealth psychotherapy sessions that did not meet the required minimum time for reimbursement. The company, based in Connecticut, provided services in at least seventeen states, including Kentucky.
The United States alleged that, between January 1, 2017, and November 30, 2022, the company submitted claims to Medicare for telehealth psychotherapy sessions that failed to meet the minimum time requirements for payment. Furthermore, these claims relied on false time records to support the services rendered. The allegations stemmed from a whistleblower lawsuit filed in federal court in Bowling Green, Kentucky.
“I commend the outstanding efforts of the attorneys and investigators who worked on this case on behalf of the United States,” said US Attorney Bennett. “Those who bill Medicare for timed services must do so accurately. We take these matters very seriously and will vigorously pursue claims of overcharging Medicare.”
Compliance Perspective
Issue
The Department of Health and Human Services Office of Inspector General (OIG) has conducted numerous investigations into fraud schemes involving companies and individuals that purported to offer telehealth, telemedicine, or telemarketing services, taking advantage of the growing acceptance and use of telehealth. These schemes raise significant concerns due to the potential harm they can cause to federal healthcare programs and their beneficiaries. The risks include: (1) the inappropriate increase in costs to federal healthcare programs for medically unnecessary items and services, and in some cases, services or items that beneficiaries never receive; (2) harm to beneficiaries, such as the provision of medically unnecessary care, items that could harm a patient, or delays in necessary care; and (3) the corruption of medical decision-making. Practitioner arrangements with telemedicine companies can also lead to criminal, civil, or administrative liability under federal laws, including the federal anti-kickback statute, OIG’s exclusion authority related to kickbacks, the Civil Monetary Penalties Law’s provisions on kickbacks, the criminal healthcare fraud statute, and the False Claims Act.
Discussion Points
- Ensure your facility’s policies and procedures for telehealth services are up to date and compliant with Medicare requirements. Include specific guidelines for accurate billing and documentation.
- Provide comprehensive training to all relevant staff on identifying and reporting fraudulent activities, including overbilling and false claims. Emphasize the importance of compliance and ethics in telehealth services.
- Conduct regular audits of telehealth services to ensure compliance with billing requirements. Monitor staff adherence to policies and procedures, and assess their awareness of reporting mechanisms for compliance concerns.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*
