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Out-of-State Telehealth Concerns, Fraud During COVID-19


The loss of privately insured in-state patients could likely hinder healthcare operations.

Telehealth has become a widely used and accepted tool during the COVID-19 pandemic. And while the aim is to improve access to care, especially for those in underserved and rural populations, the technology has also come with unintended consequences, including rise in fraud, potential access problems for such vulnerable groups, and conflict between out-of-state and in-state health providers, according to Matt Volz of Kaiser Health News.

In Montana, some were concerned about the arrival of the Minnesota-based Hazelden Betty Ford Foundation, which aimed to bring addiction and mental health treatment services to the area. Montana’s largest behavioral health provider was worried an increased number of out-of-state providers would lead to its organization losing a significant number of its privately insured patients. The loss of those privately insured patients would likely hinder the operation in Montana.

Providers who want to give services to a patient via telehealth while they are out of state should be licensed or legally permitted to practice in the states where they and their patient are physically located when services are rendered. If the patient is temporarily in another state, the provider may be legally permitted to practice there under temporary practice laws.

Last March, former CMS Administrator Seema Verma, M.P.H., temporarily lifted many federal restrictions on the use of telehealth services, which had been limited to rural areas. But in doing so brought on concerns of billing fraud and abuse and risk patient safety.

Officials feared telemedicine companies could take advantage of Medicare patients they contact at their homes because some of the largest recent Medicare fraud cases have implicated unnecessary marketing for products. In other cases, companies employed telemarketers to call thousands of patients on Medicare and offer them a free service to obtain their patient ID numbers so they can be used to bill the government.

During COVID-19, investigators have seen many fraud cases linked directly to the pandemic. Scammers were using telemarketing calls, text messages, social media platforms, and door-to-door visits to scam patients. The scammers were offering COVID-19 tests, HHS grants, and Medicare prescription cards in exchange for personal information, including Medicare details, according to the Office of the Inspector General.

Still, telehealth use has increased during COVID-19. The technology has been used to screen patients who may have symptoms, provide low-risk urgent care for non-COVID-19 conditions, provide coaching and support for patients managing chronic health conditions, and access primary care providers and specialists for medication management and other health-related concerns.

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