DOJ and HHS-OIG’s 2020 Health Care Fraud Takedown: Focus on 'Telefraud'

Utilizing telehealth platforms to deliver health-care services is an area of recent, rapid expansion. Since the worldwide spread of COVID-19, safe access to health-care services has been limited, and demand for telehealth services has surged. Alexander GC, et al., Use and Content of Primary Care Office-Based vs Telemedicine Care Visits During the COVID-19 Pandemic in the US, JAMA Net Open (Oct. 2020) (number of telemedicine consultations increased thirtyfold to more than 35 million in 2020’s second quarter). According to Epstein Becker Green’s 2020 Telemental Health Laws survey, this year alone, many providers and patients transitioned to using telehealth platforms out of necessity. Regulators implemented measures to increase access to health care through telehealth, including waivers and other regulatory modifications related to professional licensure and use of telehealth technology, and in some cases amendments to existing and/or enacted new regulations focused on telehealth utilization.

Yet, as with all areas of health care, expansion means increased risk for enforcement. At the end of September, the U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) demonstrated this point, announcing that in its 2020 “Takedown,” 345 defendants across 51 judicial districts have been charged with allegedly submitting more than $6 billion in false and fraudulent claims to federal health-care programs and to private payors—$4.5 billion of which related to telehealth. Press Release, DOJ, “National Health Care Fraud and Opioid Takedown Results in Charges Against 345 Defendants Responsible for More than $6 Billion in Alleged Fraud Losses,” (Sept. 30, 2020). While these enforcement actions actually occurred over numerous months preceding the press event (thus, the reference to a “takedown” is a misnomer), DOJ / HHS had not previously focused so sharply on enforcement activity involving telehealth providers. The 2020 Takedown warns the telehealth industry to pay attention to compliance infrastructures and efforts.