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Teleheath, Fraud and Complexity: Considerations for Policymakers

The COVID-19 pandemic drastically shifted how Americans accessed health care. Telehealth services became a main source of medical care, and as such, lawmakers, agencies and political leaders rushed to ensure that accessing telehealth was relatively easy, with as few regulatory hurdles as possible. Now, as lawmakers grapple with which of these temporary changes to make permanent for the new telehealth landscape, some are concerned about the potential for fraud in telehealth. This is understandable; in late 2020, as another wave of COVID-19 hit the United States, the U.S. Department of Justice charged over 80 medical professionals with nearly $4.5 billion in telehealth-related fraud.

OIG Statement on Telehealth Fraud: Medicare and CHAMPVA Claims

Wednesday, March 10, 2021 On February 4, 2021, the Department of Justice (“DOJ”), Office of Public Affairs, issued a Press Release (the “DOJ Press Release”) announcing that Kelly Wolfe, President of Regency, Inc., a medical billing company located in Florida, pleaded guilty to conspiracy to commit healthcare fraud through a “pernicious telefraud scheme”[1] involving fraudulent Medicare and CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) claims for medically unnecessary durable medical equipment (“DME”) supplies.  As a result of Wolfe’s criminal plea, Wolfe could face up to 13 years in federal prison.  In addition to her criminal plea, Wolfe and Regency agreed to a civil settlement of up to $20,332,516 to resolve allegations that Wolfe and her co-conspirators violated the federal False Claims Act and the federal Anti-Kickback Statute by bribing physicians to write prescriptions for DME supplies based upon non-exist

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