Why Telehealth Enforcement Remains a High Priority

Last year during Fraud by the Numbers, we discussed the huge surge in telehealth usage during the COVID-19 pandemic. Medicare telehealth services skyrocketed from 840,000 provided in 2019, to 52.7 million provided from March 2020 to February 2021.

Though we have moved past the COVID-19 pandemic shutdowns and returned to more regular in-person visits, , there were still almost 8.5 million Medicare telehealth users in 2022. The surge in telehealth services during the pandemic came, in part, because restrictions were loosened. Today, regulations around continued use of telehealth services are still in flux.

Unfortunately, fraud permeated the telehealth program from the start of the pandemic and continues to plague an otherwise popular program for patients and their providers. With telehealth here to stay, the government continues to prioritize telehealth enforcement. In July of 2022, the Department of Health and Human Services issued a Special Fraud Alert which highlighted potential telehealth schemes and explained the government’s enforcement capabilities and priorities. In conjunction with the Alert, the Department of Justice (DOJ) announced a nationwide law enforcement action aimed at combatting telehealth fraud, which involved criminal charges filed against 36 defendants, in 13 federal districts, for more than $1.2 billion in fraudulent claims.

And in June of this year, DOJ announced another nationwide law enforcement action targeting telehealth schemes, which involved charges against 78 defendants and $2.5 billion in alleged fraudulent claims. In DOJ’s press release on the 2023 enforcement action, it noted that:

The cases announced today build on earlier telemedicine enforcement actions involving over $10.1 billion in fraud. The April 2019 Operation Brace Yourself Telemedicine and Durable Medical Equipment Takedown alone resulted in an estimated cost avoidance of more than $1.9 billion in the amount Medicare paid for orthotic braces in the 20 months following that enforcement action, preserving the Medicare trust fund for necessary medical care.

That’s right. The government avoided paying more than $1.9 billion for orthotic braces.  To give perspective, Congress allocated $1.9 billion for each of FY 2023 through 2027 for block grants for substance use prevention, treatment, and recovery services. The amount of money that the government did not waste on fraudulently billed orthotics can now be spent on crucial services that are especially critical as the opioid epidemic endures.

The government clearly recognizes the deterrent effect that these huge enforcement actions have on potential bad actors in and outside of the telehealth space who are looking to defraud the government. While it may not always be measurable, healthcare fraud enforcement under the False Claims Act and criminal fraud statutes have a massive impact, whether it’s recovering almost $4 billion in ill-gotten gains from two major enforcement actions, or the dollars saved in deterrence.

These announcements likely only represent the tip of the spear in DOJ’s fraud enforcement in this area. Since qui tam actions filed by whistleblowers generally remain under seal for a year or more and take many years after that, on average, to resolve, our tracking on telehealth fraud numbers is only just beginning.          

Jacklyn DeMar is the Director of Legal Education at The Anti-Fraud Coalition