Despite evidence to the contrary, U.S. policy makers, payers, and the public continue to express apprehension that the use of telehealth is associated with increased risk of fraud and abuse. The fraudulent use of telehealth is multifaceted and complex, ranging from potentially false claims to miscoding, inaccurate billing, and kickbacks. For the past 6 years, the U.S. Federal Government has undertaken research studies to examine potential fraud issues related to the use of telehealth, including up-coding time spent with the patient, misrepresentation of the service provided, and billing for services that were not rendered. This article reviews previous efforts to assess the risk of fraud associated with the delivery of virtual care in America, concluding that there is little evidence for higher levels of fraud and abuse related to the use of telehealth.
GianiEDovcKDos SantosTJ, et al.. Telemedicine and COVID-19 pandemic: the perfect story for mark a change in diabetes care. Pediatr Diabetes2021; 22: 1115–1119.
2.
MullerACauAMuhammedS,et al.Digital mHealth and virtual care use during COVID-19 in 4 countries: rapid landscape review. JMIR Form Res2022; 6: e26041.
3.
AlmubarkBMMajrashiNAlghusunN,et al.Telehealth clinical practice guide for occupational therapy, physical therapy, and speech language pathology: a Saudi and middle eastern guide. Telemed J E Health2022; 28: 636–642.
4.
PhanJMKimSLinhDTT,et al.Telehealth interventions for HIV in low- and middle-income countries. Curr HIV/AIDS Rep2022; 19: 600–609.
5.
JohnOSrbadhikariSNPrabhuT, et al.Implementation and experiences of telehealth: balancing policies with practice in countries of South Asia, Kuwait, and the European union. JMIR2022; 11: e30755.
SchreiweisBPobiruchinMStrotbaumV,et al.Barriers and facilitators to the implementation of eHealth services: systematic literature analysis. J Med Internet Res2019; 32: e14197
ShahSJSchwammLHCohenAB,et al.Virtual visits partially replaced in-person visits in an ACO-based medical specialty practice. Health Aff. 2019; 37: 2045–2051.
Office of Inspector General. Provider Shortages and Limited Availability of Behavioral Health Services in New Mexico’s Medicaid Managed Care. OE02-17-00490; September 2019. Available at: https://oig.hhs.gov/oei/reports/oei-02-17-00490.asp
CanadyVA. Survey finds telehealth services raise potential for fraud. Mental Health Wkly2020; 30: 1–17.
19.
National Health Care Fraud Takedown. Office of Inspector General, U.S. Department of Health and Human Services; 2020. Available at: 2020 NATIONAL HEALTHCARE FRAUD TAKEDOWN (hhs.gov)
20.
Principal Deputy Inspector General Grimm on Telehealth. Office of the Inspector General, U.S. Department of Health and Human Services; February 26, 2021. Available at: HHS-OIG Principal Deputy Inspector General Grimm on Telehealth
21.
Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks. OIE-02-20-=00720, Office of Inspector General, HHS; September 2022. Available at: Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks OEI-02-20-00720 09-02-2022 (hhs.gov)
22.
Centers for Medicare and Medicaid Services. 2019 Medicare Fee-for-Service Supplemental Improper Payment Data. Available at: CMS_2019_Medicare_Fee-for-Service_Supplemental_Improper_Payment_Data
SnoswellCLStringerHTaylorML,et al.An overview of the effect of telehealth on mortality: a systematic review of meta-analyses. J Telemed Telecare2021. doi:10.1177/1357633X211023700
29.
SnoswellCLChelbergGDe GuzmanKR,et al.The clinical effectiveness of telehealth: a systematic review of meta-analyses from 2010 to 2019. J Telemed Telecare, 2021. doi:10.1177/1357633X211022907
30.
TangMHolmgrenAJMcElrathEE, et al.Investigating the association between telemedicine use and timely follow up care after acute cardiovascular hospital encounters. JACC Adv2022; 1. doi:10.1016/j.jacadv.2022.100156
31.
ColeMBLeeEKBavoustM,., et al.Comparison of visit rates before vs after telehealth expansion among patients with mental health diagnoses treated at federally qualified health systems. JAMA Open Netw2022; 5(11):e2242059.
32.
BinghamJMBlackMAndersonEJ, et al.Impact of telehealth interventions on medication adherence for patients with type 2 diabetes, hypertension, and/or dyslipidemia: a systematic review. Ann Pharmacother2021. 55: 637–649.
AlltuckerK. Guardrails needed? Telehealth fraud costs Medicare $128 M in the first year of COVID-19, feds say. USA Today2022
36.
ChenKZhangCGurleyA,et al.Primary care utilization among telehealth users and non-users at a large urban public healthcare system. PLOS ONE2022; 17: e0272605.
37.
AshwoodJSMehotraACowlingD,et al.Direct-to-consumer telehealth may increase access to care but does not decrease spending. Health Aff2017; 36: 485–491
GerkeSSternADMinssenT. Germany’s digital health reforms in the COVID-19 era: lessons and opportunities for other countries. npj Digit. Med.2020; 3: 94.
41.
Norway’s Healthcare Sector: Prioritising Digital Solutions in 2021; April 9, 2021. Available at: Norway’s healthcare sector: Prioritising digital solutions in 2021 (openaccessgovernment.org) Accessed May 4, 2023.
42.
Statistica. Global Health Care Systems Comparison—Statistics and Facts; August 30, 2022. Available at: Global health care systems comparison—Statistics & Facts | Statista. Accessed May 4, 2023.
