Will the increase in telemedicine use lead to an increase in prescription fraud?

Historically, the doctor-patient appointment was a face-to-face meeting between two people, often with a relationship built over several years. With the ongoing pandemic, however, the pressure to complete these appointments virtually has led to new issues. What used to be a person-to-person meeting has become a phone call, a video chat or photos emailed back and forth between strangers who might not even live in the same state. While the current environment supports this evolution, it also opens the doors to prescription fraud.

For an individual consumer, prescription fraud might entail:

  • Forging a prescription
  • Stealing a prescription pad
  • Stealing a prescription (either the medication or the prescription itself) from another individual
  • Identity theft to obtain a filled prescription from a pharmacy

The increasing popularity of telemedicine has added numerous layers of complexity to the potential fraud. Is the patient “doctor shopping” at various online outlets? Is the patient altering photos or simulating symptoms that it might be easier to fake online versus a personal examination? Is the patient logging in as a different individual, perhaps taking advantage of this individual’s documented medical history? It is a complex legal area.

Does this impact medical professionals?

Numerous medical facilities, physicians, companies and insurance carriers offer different types of telemedicine services. Unfortunately, there are numerous stages at which fraud could lead to criminal penalties and the loss of a professional license, including:

  • Overbilling
  • Overprescribing
  • Falsified documents
  • Falsified timelines
  • Billing for a meeting that never occurred
  • Billing for a more expensive service than was necessary
  • Accepting kickbacks for patient referrals or prescriptions

Whether these are mistakes or carefully laid plans, the penalties for prescription fraud can be devastating for both a patient and a healthcare provider.