Healthcare professionals have to follow many different sets of rules to continue practicing medicine. Physicians typically have to conform to current best practices in their area of specialization. They also need to follow state and federal laws regarding patient treatment and financial practices.
As the economy changes, the way that medical professionals provide their services to clients also changes. Recent years have seen an explosion in telehealth appointments. Patients are more likely than ever before to attend remote visits with specialists. While telehealth appointments do remove barriers to patient care in many cases, they also create a unique new set of hazards. For example, medical professionals could be at increased risk of fraud charges and licensing penalties in certain telehealth scenarios.
What types of telehealth fraud are common?
There are a variety of different reasons why a licensed medical professional offering telehealth services could potentially face criminal charges. If a conviction follows those charges, they might then be at risk of licensing penalties that could put their career at risk. Sometimes, employer policies make the telehealth situation look fraudulent to regulatory professionals.
Scenarios where telehealth providers get paid based on the number of referrals or prescriptions they write during telehealth sessions have come under intense scrutiny in recent years. If a company pressures telehealth medical providers to attempt to prescribe certain types of medications, recommend certain medical equipment or refer patients out to specific other providers, those professional demands might put a physician at risk of prosecution.
Other company practices that might constitute fraud include upcharging for a telehealth session. Some insurance companies negotiate discounted rates for telehealth services. Charging for a higher-cost in-person visit after a digital appointment is a form of fraud that could lead to prosecution. A variety of billing issues and prescribing practices related to telehealth services could draw federal scrutiny and put someone at risk of prosecution.
Healthcare providers who plead guilty to charges related to their practice of medicine are then at risk of licensing penalties. It is common for disciplinary hearings to follow a conviction or guilty pleas, and the healthcare provider could be at risk of penalties up to the revocation of their medical license.
Professionals who understand the activities that might draw unnecessary scrutiny can avoid high-risk employment opportunities or change their personal practices for optimal professional stability. In the event that someone is placed under scrutiny despite their best efforts, fighting criminal charges and responding assertively to licensing issues and disciplinary efforts are important for healthcare providers accused of some form of telehealth misconduct.
