Telehealth Medicare Fraud in 2024: A Growing Threat That Demands Whistleblower Action
The explosive growth of telehealth services during the COVID-19 pandemic created unprecedented opportunities for healthcare innovation—and unfortunately, for fraud. Telehealth fraud spread “like wildfire” during the pandemic, and enforcement actions continue to target fraudulent schemes that exploit virtual care systems and billing violations.
In 2024, federal regulators remain vigilant about telehealth fraud, with the Department of Health and Human Services Office of Inspector General (HHS-OIG) identifying 1,714 high-risk providers with fraudulent billing for telehealth services to the tune of $127.7 million in Medicare fee-for-service payments during the first year of the pandemic alone. These numbers represent just the tip of the iceberg in a fraud scheme that continues to evolve.
Common Types of Telehealth Medicare Fraud
Telehealth fraud schemes often involve sophisticated networks of bad actors exploiting the remote nature of virtual care. A purported telehealth company typically then pays a medical provider to review records and electronically sign orders or prescriptions for medically unnecessary durable medical equipment, genetic testing, or prescription medications. The medical provider typically does not interact with or otherwise treat the Federal health care program beneficiary prior to ordering the medically unnecessary items and services.
The most prevalent violations include:
- Audio-Only Billing Fraud: Billing primarily for audio-only telehealth services can be an indication that providers are cold calling beneficiaries to increase billings for DME and other services.
- Unnecessary Remote Services: Kickbacks, billing for visits that never happened, and billing for unnecessary services or medications are among the issues already uncovered.
- Remote Patient Monitoring Abuse: Implement additional safeguards to ensure that remote patient monitoring is used and billed appropriately in Medicare. Require that remote patient monitoring be ordered and that information about the ordering provider be included on claims and encounter data for remote patient monitoring.
- Complex Billing Violations: Examples of seven measures that may indicate fraud, waste, and abuse in telehealth services were billing both a telehealth service and a facility fee for the same visit, billing telehealth services at the highest most expensive level, and billing for high average number of hours of telehealth services per visit.
The Scale of the Problem
The financial impact of Medicare fraud is staggering. The Department of Health and Human Services (HHS) estimated a combined total of over $100 billion in improper payments in the Medicare and Medicaid programs in fiscal year 2023. Telehealth fraud represents a growing portion of this massive loss to taxpayers.
In 2022, HHS conducted a review of telehealth services during the first year of the COVID-19 pandemic… Out of about 740,000 providers who billed Medicare for telehealth services during 2020, the study reviewed claims for about 1,700 of them, finding that 100% of providers reviewed “had concerning billing on at least one of seven measures that may indicate fraud, waste, or abuse.”
Red Flags Healthcare Workers Should Watch For
Healthcare professionals and support staff are often the first to notice suspicious patterns. Warning signs include:
- Pressure to provide telehealth services to patients you’ve never met
- Requests to sign orders for medical equipment without proper patient evaluation
- Companies offering unusually high payments for telehealth consultations
- Billing for services at the highest complexity levels without justification
- Cold-calling Medicare beneficiaries to solicit telehealth services
How to Report Telehealth Medicare Fraud
If you suspect telehealth Medicare fraud, reporting it through proper legal channels is crucial. When you notice discrepancies on your EOBs or MSNs, such as names of providers who never treated you or types of medical services that you never received, report it to the OIG’s fraud hotline.
For healthcare workers with inside knowledge of fraud schemes, becoming a medicare fraud whistleblower may be the most effective path forward. The False Claims Act provides substantial protections and financial incentives for individuals who report fraud with credible evidence.
Whistleblower Protections and Rewards
Federal law provides robust protections for individuals who report Medicare fraud. At the federal level, the False Claims Act (FCA) offers protection. This act forbids employers from firing, demoting, or harassing employees for reporting fraud. Additionally, in some cases whistleblowers receive at least 15% but not more than 30% of recovered funds.
The financial rewards can be substantial. In 2024 alone, whistleblowers filed a record 979 qui tam cases resulting in over $2.4 billion in settlements and judgments. The SEC awarded more than $255 million to 47 individual whistleblowers in fiscal year 2024, including a $98 million award split between two whistleblowers.
Why Professional Legal Representation Matters
Telehealth fraud cases are complex, involving intricate billing regulations and evolving federal policies. Telehealth arrangements commonly involve coordination and potential referrals among multiple parties and by their nature present a degree of inherent risk. Seeking federal reimbursement for telehealth services may subject a provider to FCA if done in violation of legal restrictions.
The Howley Law Firm, located in New York, specializes in whistleblower cases and has over 30 years of experience protecting the rights of individuals who report fraud. Here at The Howley Law Firm, we specialize in employment and whistleblower law. Contact us today if you need legal representation in New York. The firm’s commitment to fighting for justice is evident in their track record: We have represented clients in some of the largest and most important cases, including an $80M settlement in a discrimination class action. We’ve won millions of dollars for healthcare professionals, employees of large corporations, live-in nannies, and restaurant workers.
What sets The Howley Law Firm apart is their understanding that more than your legal rights are at stake. You also need to protect your reputation and your career. We help you understand your rights and all of your options. Their approach combines the high-level legal expertise typically reserved for corporations with personalized attention to individual clients.
The Time to Act is Now
As telehealth continues to evolve in 2024 and beyond, fraud schemes are becoming more sophisticated. Enforcement actions since 2022 show there is no sign of telehealth fraud slowing down, especially in cases brought by whistleblowers. With Medicare losing billions annually to fraud, whistleblowers play a crucial role in protecting taxpayer funds and ensuring healthcare programs serve those who need them most.
If you have knowledge of telehealth Medicare fraud, don’t wait. The statute of limitations for False Claims Act cases provides limited time to act, and early reporting often leads to stronger cases and better outcomes. Every year, the government pays hundreds of millions of dollars to whistleblowers who help stop fraud, waste, and abuse in the Medicare and Medicaid programs. Whistleblowers are also entitled to significant legal protections.
Contact an experienced whistleblower attorney today to discuss your situation confidentially and learn how you can help stop telehealth fraud while protecting your rights and earning the compensation you deserve for your courage in speaking out.