How Telehealth Providers can Mitigate Healthcare Fraud Risk

Among health IT stakeholders, it is well-known that with greater technology utilization comes a greater risk of healthcare fraud and, by extension, government scrutiny. Telehealth providers have learned this lesson firsthand after utilization soared to new heights during the COVID-19 pandemic, and the Department of Justice started to examine the telehealth arena more closely.The DOJ has cracked down heavily on telehealth-related healthcare fraud in the last few years. One estimate shows that enforcement actions from 2020 through 2023 led to criminal charges against more than 175 individuals and allegations of over $8 billion in telehealth fraud.Healthcare law experts noted that the unique characteristics of telehealth that benefit patients also increase the potential for fraud.

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Telehealth providers are ultimately responsible for remaining in regulatory compliance and avoiding fraudulent activity. In addition to staying up-to-date on regulatory changes, providers need to understand how the DOJ approaches fraud enforcement in the telehealth arena and establish protocols to reduce fraud risk.Though telehealth faced DOJ scrutiny before the pandemic, there has been an uptick in enforcement in the last few years. Among these, one case stands out as an especially vital lesson for telehealth providers: the Done Health indictments.

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