Telehealth Vendor Guilty Plea Highlights Quiet Debate

| Aaron Turner-Phifer
gavel and stethoscope

According to an announcement made by the U.S. Department of Justice on Monday October 15th, the telehealth vendor HealthRight and its CEO Scott Roix pled guilty to charges of fraud and conspiracy.  All told, four people and seven companies, including many compounding pharmacies, were charged with a $1 billion fraud scheme in which the companies sought to bill insurers for marked up and bogus products provided to patients.

There’s nothing new about fraud in healthcare. For as long as there’s been a way to cheat the system, there have been those willing to roll the dice. From one perspective there’s nothing terribly alarming or illuminating about the fact that HealthRight has been caught defrauding the healthcare system. Fraud is common enough that health insurers spend millions every year to try to prevent and capture perpetrators.

In this case, HealthRight is another in a long list of bad actors that just so happens to be a telemedicine company.

This feeling holds truth, but it underlined a theme that is always present when we discuss telehealth: trust. Last week’s announcement reminded me of the rarely discussed debate taking place among providers and payers alike: can I trust telehealth to deliver on the promises of its most ardent supporters?

Make no mistake about it – telehealth and all its variants hold the potential to revolutionize how patients and providers interact with one another. However, as with any new technology, it’s not enough that the technical components work; success is dependent on one trusting the company to deliver.

Telehealth has proven it can be a tool to solve specific problems. Federal and state policymakers have responded to these results by removing some barriers that have slowed the adoption of telehealth. Advocates argue that policymakers have been too slow to recognize the potential of telehealth. They point out that policymakers remove some barriers but choose to leave in place others. For example, Congress removed Medicare’s location restrictions for telehealth services treating opioid addiction but left in place the restriction for other medical services covered by Medicare.

I’ve always been struck by the pace of change sought by some. While there are many faults with the current U.S. healthcare system, there are just as many, if not more, positives.

Telehealth seeks to disrupt a foundational pillar of medicine – how patients interact with their doctors. To me there’s nothing wrong with stakeholders moving forward cautiously to ensure that disruption does not have unintended and potentially harmful consequences for patients.

This is a classic better-the-devil-you-know-than-the-devil-you-don’t situation for the U.S. healthcare system. Patients, providers, and regulators reflexively trust the devil they know. Often serving as the greatest skeptic is a government that slows change while cloaked in the mantra of consumer protection.

So, absent data and time, how does one overcome this lack of trust?  

Validation from an independent, third-party expert has historically helped bridge this gap between new models and a skeptical community of stakeholders. Regulators and payers have utilized national accreditors in their efforts to deploy innovation while protecting patients from unintended consequences.

URAC’s nearly three decades of experience accrediting health care organizations has shown that those who seek accreditation not only are those dedicated to the key tenants of consumer protection and continuous quality improvement, but they also tend to be those who are the best to do business.

Click here to learn more about URAC’s Telehealth Accreditation.

Click here to learn about the Telemed Leadership Forum 2019

image of Aaron Turner-Phifer

Aaron Turner-Phifer, Vice President, Government Relations and Policy.

Aaron Turner-Phifer, vice president of government relations and policy, has nearly a decade of experience advising and crafting public policy at the federal, state, and local levels. He has experience working on health care quality initiatives and public policy that impacts Medicare, Medicaid, and Health Insurance Marketplace enrollees. He is an expert political and policy analyst with a unique understanding of the intricacies associated with the development of health care policy. He achieved his Master of Health Administration degree from the George Washington University.

Views, thoughts and opinions expressed in my articles belong solely to me, and not necessarily to my employer.

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