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Opinion: Telemedicine May Create Fertile Ground for Fraud

With the coronavirus pandemic still gripping the planet, one of the newest avenues for con artists is in the field of telemedicine, in which health diagnoses and monitoring are rendered remotely and electronically.

by The Augusta Chronicle / May 1, 2020

(TNS) — Where some people see a chance to improve society, others see a chance to rip someone off.

One of the newest avenues for con artists is in the field of telemedicine, in which health diagnoses and monitoring are rendered remotely and electronically. With the coronavirus pandemic still gripping the planet, working remotely has become more of a necessity, and that includes telemedicine.

As COVID-19 escalated in America in March, the Trump administration announced the lifting of several federal restrictions on telemedicine. Among the lifted restrictions: Telemedicine providers can waive patient deductibles and copayments during the coronavirus crisis. Normally that could be considered a kickback because it can discourage patients from complaining about charges or encourage medical services to be overused.

But the federal government apparently considers those lifted restrictions a calculated risk to promote telemedicine at a time in our country when it's needed most. Pressure is even growing to make those changes permanent.

What a wretched idea. That plows fertile ground for fraud, and the feds know it.

Investigators recently revealed a vivid example of how telemedicine providers can game the system for their own twisted benefit. Medicare and Medicaid beneficiaries in Augusta and several other cities throughout the Southern District of Georgia had their identities stolen in a massive nationwide fraud scheme. At a cost of $410 million, it's easily the biggest fraud scheme ever prosecuted in the Southern District's history.

Recently the district announced charges against the 22nd defendant in the fraud. Scott M. Hirsch operates the California company JI Medical Inc, which deals in "durable medical equipment" - basically anything from crutches to blood pressure cuffs.

Here's how prosecutors say the con worked: Allegedly Hirsch conspired to pay kickbacks to doctors who ordered his company's medical equipment based on telemedicine consultations - only those consultations never occurred. Medicare or Medicaid got billed for the equipment, meaning your tax money allegedly went straight into Hirsch's pocket.

Not just his pocket, though. Other charges have been filed against eight physicians, two nurse practitioners, two operators of telemedicine companies and two brokers of patient data.

"Telemedicine is an important tool for legitimate providers - but paying kickbacks is not part of telemedicine and will not be tolerated under any circumstances," U.S. Attorney Bobby Christine said.

"Anytime you open a program of this importance in such a short period of time, you are opening the door to all types of fraud," retired FBI agent, forensics expert and attorney Jason G. Weiss told "COVID-19 was thrust upon us, and medical providers as well as law enforcement are all trying to adapt to this new virtual reality. With the creation of any new program in a rapidly condensed period of time, there will be some level of organized chaos involved, and cybercriminals will try and take advantage of it as was allegedly done here."

This huge fraud case couldn't make the message clearer: Telemedicine restrictions were put in place for a reason. Put them back as soon as possible.

And if you suspect telemedicine fraud or kickbacks affecting you or someone you know - and that includes COVID-19 fraud - call the FBI hotline at 1-800-CALL-FBI.

©2020 The Augusta Chronicle (Augusta, Ga.). Distributed by Tribune Content Agency, LLC.

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