April Fraud Fridays – Using Telehealth Providers: How To Spot Possible Fraud

April 14, 2023

The COVID-19 pandemic continues to change many aspects of our daily lives and the health care industry is no exception. Several laws and regulations went into effect as a result of the pandemic to help improve access to telehealth, including Medicare and Medicaid beneficiaries. In fact, according to a recent study by the Government Accountability Office found that from March 2020 to February 2021, telehealth use increased tenfold among Medicare recipients.

And while telehealth has made it easier for individuals to receive care from their primary provider, it’s also become a mechanism for fraud, particularly when people are seeking telehealth service from a new provider or a provider who has solicited an individual about a service. From less-than-reputable providers looking to profit from insurance claims to potentially shady operators looking to steal personal information, telehealth is one sector that Prime Therapeutics Special Investigations Unit (SIU) has been watching for some time.

Fortunately, like so many other schemes, telehealth fraud can be easy to spot if you know what to look for. Here are some tips to keep in mind if you have or are about to schedule a telehealth visit.

  1. Call your health plan to make sure your telehealth provider is reputable and in your network. What’s more don’t complete health questionnaires or schedule an appointment until you know the provider is legitimate and/or in-network.
  2. Check all bills to make sure you received all services you’ve been charged for. Members have reported billing issues or have even been billed for services they haven’t received.
  3. Talk with your primary care doctor before getting medicine from a telehealth provider. Some members have participated in what they thought was a telehealth visit and have been prescribed medications only to never receive the drugs. What’s more, telehealth providers don’t always have access to your medical or medication history and can prescribe medications that could put your health at risk.

Remember you are your own best advocate, but also trust your gut – if something seems wrong, report concerns to your health plan.

Stay tuned for more fraud tips next week, and watch for more information on Twitter @Prime_PBM.

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