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Telemedicine Takedown; Cue the Copays; Winners for Satisfaction

Welcome to Telehealth Roundup, highlighting news and features about emerging trends in telemedicine and telehealth.

Telemedicine Schemes Bring Federal Charges

The Department of Justice charged 345 people, including more than 100 doctors, nurses, and other licensed medical professionals, in what the agency called its largest healthcare fraud case ever.

Defendants were charged with submitting more than $6 billion in false and fraudulent claims to federal health care programs and private insurers, the justice department said.

The largest amount — $4.5 billion in allegedly false and fraudulent claims submitted by more than 86 criminal defendants in 19 judicial districts — involved telemedicine schemes.

In some cases, business executives paid doctors and nurse practitioners to order unnecessary durable medical equipment, genetic and diagnostic testing, or medications, either without any patient interaction or with only a brief phone conversation with patients they had never met, prosecutors said. Fraudulent claims were submitted to Medicare and other government payers and proceeds laundered through international shell corporations and foreign banks, according to court documents.

CMS’s Center for Program Integrity separately announced that it revoked the Medicare billing privileges of 256 other medical professionals for their involvement in fraudulent telemedicine schemes.

“This nationwide enforcement operation is historic in both its size and scope, alleging billions of dollars in healthcare fraud across the country,” Acting Assistant Attorney General Brian Rabbitt said in a statement. It follows the 2019 Operation Brace Yourself takedown, a $1 billion orthotic brace scheme also involving telemedicine fraud.

Insurers Roll Back Coverage

UnitedHealth Group and Anthem customers may face out-of-pocket charges for certain telehealth visits starting Oct. 1, STAT reported.

Until Sept. 30, UnitedHealth had covered the full cost of telehealth visits with in-network providers at no cost to patients. Now, depending on their benefits plan, some UnitedHealth members will be responsible for copays, coinsurance, and deductibles for virtual medical care not related to COVID-19.

Anthem also will stop waiving the cost of copays, coinsurance, and deductibles for virtual visits not related to COVID-19 as of Oct. 1 for some members.

It’s not clear how much patients will pay for telehealth services or how these costs will compare with in-office visits.

“I think it’s irresponsible to decrease payment for the kind of care that so many patients are receiving,” Adam Licurse, MD, executive director of the virtual care department at Brigham and Women’s Hospital and Faulkner Hospital in Boston, told STAT.

“For many patients, it’s their lifeline right now — it’s the only way that they’re feeling comfortable or safe receiving care.

Potential effects on providers also are concerning, Licurse said: “To have a provider feel financial pressure to offer less telehealth and bring more patients into the office — because they have to pay the bills and keep the lights on and keep their practice running — is a pressure providers shouldn’t have to face.”

Some insurers, including CVS Health and BlueCross BlueShield Tennessee, already have extended their expiration date until the end of this year, and others may follow suit.