ATA Comments on National Health Care Fraud and Opioid Takedown and International Telemarketing Scammers

WASHINGTON, D.C., OCTOBER 2, 2020 – In response to the announcement from the U.S. Department of Justice related to more than $6 billion in false and fraudulent claims to federal health care programs and private insurers, including schemes involving call centers and international telemarketing scammers, the American Telemedicine Association (ATA) issued the following statement:

“We are appalled at the scammers targeting Medicare and Medicaid beneficiaries – and any patient – and their intent to deceive. These call centers and international telemarketing centers risk patients’ safety and do not represent the legitimate practice of telemedicine or the well-established operations of health systems and telehealth companies, nor do these organizations represent the membership and mission of the American Telemedicine Association. The cornerstone of these arrangements is to facilitate illegal kickbacks and bribes for medically unnecessary services and DME (durable medical equipment) suppliers and should not be confused with highly credible telehealth providers that comply with state and federal regulatory requirements and have implemented clinical protocols consistent with the standard of care,” said Ann Mond Johnson, CEO, the American Telemedicine Association (ATA). “We trust that the Department of Health and Human Services Office of Inspector General (HHS-OIG) will not confuse these charlatans with legitimate telehealth providers that have invested heavily in quality and integrity programs and operate in the best interest of patients.”

“COVID-19 has driven unprecedented demand for telehealth services as patients seek more convenient care, but historic legacies of “pill mills,” illegal online pharmacies, or illicit telemarketing schemes to defraud Medicare have rightly led to concern. It is important to note that these examples of illegal operations are not legitimate telemedicine services. Indeed, as Gary Cantrell, Deputy Inspector General for Investigations at the Office of Investigations at the U.S. Department of Health and Human Services said in 2019, ‘The telemedicine we are talking about is basically a tele-scam.’ We agree that it is critical to differentiate between telehealth providers and fraudulent outfits as the latter can threaten public confidence in new technologies and care models that benefit growing numbers of patients and providers,” said Mond Johnson.

“As part of the ATA’s Policy Principles, we support and advocate for best practices that ensure the integrity of virtual care programs, if not already established. Federal and state policies should leverage technology to optimize program integrity measures and prevent fraud and abuse without providers being required to see patients in person. In addition, the Taskforce on Telehealth Policy just released its final recommendations on aligning standards, quality, payment, and program integrity. One of our key findings states that telehealth is a modality of care and, as such, it should be held to the same standards and quality measures as in-person care wherever possible and appropriate.

“There are state and federal laws and regulations in place to ensure program integrity and to ensure that Medicare beneficiaries have access to safe telehealth care. The people responsible for this recent activity are criminals; there is no additional legislation or regulation that could prevent such activity. Our focus should be on developing fraud detection models, systems, and audit mechanisms to catch illegal prescribing and billing,” concluded Mond Johnson.

The ATA recently published a brief which included the following attributes of legitimate telemedicine providers:

  • Compliance with the same state and federal regulatory requirements as traditional health care providers that treat patients face-to-face
  • Access to licensed and board-certified providers
  • Medically appropriate uses and emphasis on clinical protocols consistent with the standard of care
  • Safe and secure technology
  • Clear identification of patient and provider, alongside valid consult report and medical record

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