Bass, Berry & Sims attorney John Kelly spoke with Matthew Wetzel – Associate General Counsel, Compliance Officer at GRAIL – for the American Health Law Association’s (AHLA) Speaking of Health Law podcast about the Department of Justice’s (DOJ) crackdown on fraud schemes involving telemedicine. Specifically, John and Matt spoke about September 2020 enforcement actions by the DOJ and other federal agencies related to allegations of healthcare fraud involving telemedicine schemes by durable medical equipment suppliers, genetic testing labs, and substance abuse disorder treatment facilities. “What was unique about this [action] – it wasn’t really a focus on billing or coding for telehealth services, it was really what was coming out of the telehealth communications between providers and patients. It was focused on the use of telemedicine as a platform to order medically unnecessary services and items that were ultimately billed to federal healthcare programs,” said John.
John offered the following perspective to providers and health systems on important takeaways from this enforcement action, saying one of the most important lessons learned for physicians and providers is “the basic understanding of how telemedicine works. Telemedicine is constantly evolving. The rules around it are constantly changing.” Understanding the risks is key.
The full episode, “DOJ’s Telemedicine Fraud Crackdown—What Providers Need to Know,” was released on May 18 by the AHLA’s Speaking of Health Law podcast and is available at the link or wherever you get your podcast content.