The U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) is alerting the public about a remote patient monitoring fraud scheme.
According to the watchdog agency, “unscrupulous companies are signing up Medicare enrollees for this service, regardless of medical necessity.” They may do it through phone solicitation, ads on the Internet or even television commercials.
Beneficiaries may receive calls from durable medical equipment companies (DME) or pharmacies. Medical equipment may or may not be sent to the Medicare beneficiary. In most instances, there isn’t even monthly monitoring. Regardless, the billing begins.
Remote Patient Monitoring Takes Off
As we have written about previously, when the pandemic struck, a public health emergency was declared, allowing the government to issue waivers that gave providers more flexibility in how to treat patients. While necessary for patient care, the flexibility also opened the door to increasing opportunities for remote patient monitoring fraud.
The evolution of the technology also has led to a further increase in fraudulent activities. Whereas, once physicians could simply engage with patients face-to-face on screen, the ability to use various wearable equipment now allows healthcare providers to obtain a patient’s blood pressure, heart rate, pulse oxygenation and even blood sugar.
Providers using patient monitoring services must comply with CMS guidelines, and those guidelines should be confirmed by the patient monitoring service provider in advance of delivering the services. They include patient eligibility, consent, certified electronic health records, allotted time per patient, patient care plan, coding compliance and good record keeping for auditing purposes.
In July 2022, HHS-OIG issued a special fraud alert that warned healthcare practitioners to exercise caution when entering into arrangements with purported telemedicine companies. It outlined several of the schemes being used that may implicate multiple federal laws, including the federal Anti-Kickback Statute. That law prohibits knowingly and willfully soliciting or receiving (or offering or paying) any remuneration in return for (or to induce), among other things, referrals for, or orders of, items or services reimbursable by a federal healthcare program.
OIG Work Plan Includes Remote Patient Monitoring Analysis
In April, HHS-OIG added to its Workplan that it would review the use of remote patient monitoring services in Medicare. The OIG Work Plan sets forth various projects including audits and evaluations that are underway or planned to be addressed during the fiscal year and beyond by OIG’s Office of Audit Services and Office of Evaluation and Inspections.
The agency stated that the review would “look at the extent to which the use of remote patient monitoring services has changed, the nature of remote patient monitoring services being used by Medicare enrollees, and the characteristics of enrollees using remote patient monitoring services. This review will also determine the extent to which provider billing for remote patient monitoring services may indicate fraud, waste, or abuse.”
Toolkit for Analyzing Fraud Risk
Also in April, the watchdog agency released a toolkit that provides detailed information on methods to analyze telehealth claims to identify program integrity risks associated with telehealth services.
The agency stated: “Gaining a better understanding of the program integrity risks associated with telehealth services can help policymakers and stakeholders develop necessary safeguards and address individual cases of potential fraud, waste, and abuse. Doing so will help ensure that the benefits of telehealth are realized while minimizing risk in an effective and efficient manner.”
The analysis also can help identify providers whose billing may pose a risk and warrant further scrutiny, OIG stated.
Do Your Due Diligence
For healthcare providers who contract with these organizations, conduct your due diligence to ensure they comply. Healthcare providers must have a relationship with those patients who are being billed for these services. If found guilty, you can be excluded from participating in federal healthcare programs, lose your medical license, face fines and, of course, incur significant legal expenses.
The Health Law Offices of Anthony C. Vitale can assist you with these efforts and represent you should you become the target of an audit. Call 305-358-4500 or e mail firstname.lastname@example.org.