Accreditation Provides Powerful Protection Against Telehealth Fraud
To paraphrase Charles Dickens, it is in some ways the best of times and the worst of times for telehealth advocates in the United States today.
With the COVID-19 pandemic upending norms in society, once-wary practitioners and patients are now accepting telehealth as an effective way to deliver high-quality health care. Many are learning in real time that telehealth is far more adaptable and effective than they may have realized. Telehealth advocates feel justly proud to see how tools and tactics are helping to alleviate a challenging situation.
Unfortunately, because telehealth is taking center stage under a time of national duress, standards and regulations may be overlooked in the name of expediency as America and the world confronts a mammoth health crisis. While it may make sense in terms of risk and reward to relax regulations and restrictions to speed vital services to vulnerable patients, the scenario inadvertently makes it easier for fraud to occur and bad actors to operate in the telehealth space, experts warn.
“There are unscrupulous providers out there, and they have much greater reach with telehealth,” Mike Cohen, an operations officer with the Health and Human Services Inspector General’s Office, which investigates health care fraud, recently told Kaiser Health News. “Just a few can do a whole lot of damage.” Cohen added that anti-fraud “guardrails have been removed under this epidemic.”
It’s a brave new world for telehealth providers and advocates,” says Shawn Griffin, president and CEO at URAC, the nation’s pre-eminent accreditor of telehealth services. “The COVID-19 pandemic is challenging telehealth providers in almost unimaginable ways,” he says. “They continue to rise to the occasion by focusing on the delivery of quality health care,” Griffin adds.
However, there is a risk that some of those “unscrupulous providers” will make headlines in the coming months with shoddy work resulting in patient harm and financial mismanagement, and that’s enough to stop telehealth’s growth in its tracks.
Savvy telehealth providers are looking at accreditation as one way to separate themselves and demonstrate program integrity. Griffin adds “Accreditation can act as a firewall against fraudsters.”
URAC’s Telehealth Accreditation Program (TAP) promotes access to safe, high-quality care regardless of the telehealth model in use or type of clinical services offered. Griffin says, “Our five core standards provide the baseline requirements for accreditation, including rigorous professional oversight and quality and patient safety modules; that helps ensure performance integrity for telehealth professionals.”
Telehealth organizations that attain URAC’s telehealth accreditation have proven to an independent third-party body that they have met rigorous provider credentialing, clinical director requirements, and personnel education and training standards. URAC’s telehealth accreditation program also has robust quality and patient safety safeguards.
“If an organization makes the effort to become URAC accredited for telehealth services, that serves to show its commitment to simultaneously fighting fraud and advancing quality telehealth for all patients,” Griffin says.