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One of the largest healthcare fraud schemes to date ensnared 24 individuals — five of whom were US telemedicine executives — and could amplify concerns regarding malpractice in telemedicine and curb its adoption.
Business Insider Intelligence
The scam — which affected hundreds of thousands of seniors and resulted in over $1 billion in Medicare losses — alleges that the defendants received kickbacks from medical equipment companies for prescribing Medicare beneficiaries unneeded orthopedic braces.
Here’s what it means: This is the latest case to poke holes in telemedicine’s credibility and trustworthiness.
- Recent research shows telemedicine doctors overprescribe antibiotics to children. Over half of children who met with a telemedicine doctor for acute respiratory infections wound up with an antibiotic prescription, compared to only 31% who went to their doctors’ offices, according to recent research. And telehealth doctors were more likely to bypass other guidelines — like running lab tests for potential strep throat cases — and prescribe antibiotics for viral illnesses, which aren’t assuaged by antibiotics.
- And it’s not the first time providers used telehealth programs to fraudulently extract money from government-funded programs. In November 2018, a team of providers in Tennessee was indicted in a scandal that swindled $65 million from TRICARE, a US government healthcare program for military service members, per mHealth Intelligence. The providers paid Marines and their dependents to file prescriptions — which they later billed to TRICARE — with conspiring pharmacies after a phony telehealth consult gave them the go-ahead.
The bigger picture: Growing concerns around fraudulent telemedicine and wasteful spendingcould stymie adoption.
- Insurers may roll back investments in telemedicine. More US insurers are deploying telemedicine as it pervades the industry, and many are enthusiastic about its potential effects: 70% of healthcare executives rank telemedicine as a high or top priority for their organization. But if providers have concerns about having to pay out for overprescriptions and wasteful medical spending that stems from telemedicine, they may be hesitant to steer customers toward virtual care.
- Consumers’ trust in and use of telemedicine may decline if more news of shady practices surfaces. US consumers’ trust in healthcare is already declining: Consumer willingness to share health data with healthcare players declined an average of 9% year-over-year (YoY) in 2018. Scams might prune back the already-lowconsumer interest in adopting telemedicine, especially among seniors, who already tend to have reservations about digital health tech.
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See Also:
- CMS is loosening regulations on telehealth services offered in Medicare Advantage plans
- CVS and Amazon’s showdown is intensifying
- Amazon released new software that makes its Alexa voice assistant HIPAA-compliant
Source: Business Insider – zlarock@businessinsider.com (Zoë LaRock)