Expansion of telehealth services attracts regulation scrutiny
Ever since the COVID pandemic pushed telehealth to the forefront of American healthcare modalities, the genie has emerged from the lamp to quite a mixed crowd of cheerleaders and cheaters.
In March 2024, telehealth’s now proven benefits spurred four Republican and three Democratic United States House of Representative members to introduce legislation to extend telehealth flexibilities for Medicare beneficiaries.
The bill would permanently end geographic restrictions for certain telehealth services and allow rural health clinics and federally qualified health centers to receive Medicare reimbursements for the services.
Additionally, “The Telehealth Modernization Act of 2024” would add audio-only telehealth coverage for Medicare beneficiaries in an effort to better serve seniors and rural patients lacking internet connectivity.
At the same time, no fewer than nine state legislatures have acted on bills in recent sessions to either more closely regulate or expand telehealth accessibility.
Expansion includes services provided by nutritionists and dieticians (Arizona and Georgia); veterinarians (Florida); physicians, nurse practitioners, and physician assistants for cosmetic consultations (Utah); Medicare reimbursed remote ultrasounds and fetal non-stress tests (Virginia); and injections for treating syphilis with injections administered by medical assistants under physician supervision via interactive audio and video (Washington).
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States move on telehealth services restrictions
Meanwhile, legislatures in Florida, Georgia, and Indiana have moved to tighten scrutiny of various telehealth practitioners ranging from dentists to dietetic and nutrition care specialists to out-of-state healthcare providers.
Further, lawmakers in seven states – Arizona, Colorado, Georgia, Kansas, Vermont, Virginia, and Washington – have recently taken steps to enter various licensure compacts in the aim of easing burdens of licensing process for out-of-state care professionals.
At the national level, telehealth’s popularity has spurred Congress to explore improved cost savings to taxpayers. At a March 2024 hearing by the House Ways & Means Committee, lawmakers and witnesses sparred over whether some telemedicine visits with providers should be reimbursed at a lower rate than in-person patient visits.
One issue was whether lower reimbursements would impair the ability of independent physicians in rural areas to cover overhead expenses. Advocates for less pay, however, argued that telehealth visits require less time, space, staff, and equipment and thus should cost payers less.
Fraudulent opportunists drawn to telemedicine
Of course, where there’s telehealth and telemedicine opportunities you might also expect villainous opportunists. In a Boston federal court, a 40-year-old Florida man agreed to plead guilty to a $110 million telemarketing scheme involving distribution of medically unnecessary durable medical equipment.
Steven Richardson, owner of Expansion Media and Hybrid Management Group, was charged with coordinating with medical staffing companies to find healthcare professionals willing to sign off on prepopulated equipment orders, often without direct contact with patients. Richardson, who now faces up to ten years in prison a fine of $250,000, then allegedly supplied the orders to telemarketing companies that sold them to DME suppliers.
In California, Dr. Raphael Malikan was sentenced to 37 months in prison for illegally dispensing 702 pills containing opioids and other controlled substances to an undercover law enforcement officer during telemedicine sessions without conducting required evaluations and identity verifications. Dr. Malikan must also pay a $20,000 fine.
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