HealthRight – Where They Went Wrong

Recent News

Recent headlines have brought telemedicine into the spotlight, providing the opportunity to dive into what real telemedicine is and what it can do.  Telemedicine is intended to be a technological supplement to traditional medical care, meant to increase access to care and the number of convenient options for patients.  To expand upon what encompasses telemedicine, we’re going to dive into a recent headline and explain what went wrong, how, and where telemedicine is going.

Why HealthRight Is Not Typical

This HealthRight story is newsworthy because it showed how telemedicine can be manipulated if done incorrectly.  It also resulted in multiple arrests, heightening interest in the story. Four men were arrested, and along with seven companies, face a 32-count indictment charging them with conspiracy to commit health care fraud, introducing misbranded drugs into interstate commerce and mail fraud.  Ultimately, the high value of the health care fraud, submitting $931M in fraudulent claims, raised numerous red flags.

HealthRight deceived thousands of patients and over 100 doctors  Here’s what they would do: they’d call a potential patient, advertising themselves as a genuine telemedicine provider able to discuss any health concerns.  The company would goad vulnerable customers into discussing medical ailments, then the caller would suggest ‘medications’ for the patient, whether or not the prescriptions were needed or likely effective.

HealthRight would call licensed medical providers to approve the electronic consult using the telemedicine general supervision clause, under the guise that a legitimate telemedicine consult was conducted. HealthRight would claim that the patient requested the specific drug. Doctors approved prescriptions not knowing that the companies and officials massively marked up prices of the wrongly prescribed drugs, and then billed private insurance.

The consideration regarding drug recommendations was minimal, but the pricing was very intentional.  In partnership with fraudulent pharmacies, drug pricing was inflated for HealthRight to receive a kickback for prescribing certain drugs, while the pharmacy would also receive additional profits.  Returns would be realized when HealthRight would file a claim on behalf of the patient to insurance companies citing fraudulent information or citing services that did not occur. HealthRight ended up defrauding various private insurance companies an estimated $174M for consults that never happened and replacing rejected claims with up-charged drugs.  The entire business model was the equivalent of the online drugstore scams that previously proliferated email boxes and internet advertising.

The Difference

The Center for Connected Health Policy promotes telemedicine as an ‘alternative to a traditional office visit’ and requires that facilitates “patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers”.  Ideally, telemedicine attempts to emulate a noteworthy component that traditional office visits have – face-to-face interaction with your medical provider.  This is precisely where HealthRight exploited the system by only speaking to patients over the phone and classifying it as a telemedicine consult.  Video is not defined as a requirement for telemedicine, but it has increasingly become an industry expectation.

Telemedicine at its core maintains the purpose to make healthcare services more accessible and to quite literally, speak to a provider in the privacy one’s home.  Whether it’s a doctor, nurse, or behavioral care provider, direct communication makes telemedicine more productive. It helps extend access to establish the crucial relationship to a trusted provider that is necessary for telemedicine.  These relationships have been shown to improve outcomes and decrease the total cost of care, with significant reductions in expensive ER visits, as patients frequent providers they trust.

Telemedicine is only intended to augment existing care workflows instead of bypassing them the way HealthRight did.  Amongst many other benefits, telemedicine has actually been shown to be an effective means to diagnose and prescribe medicine.  It has even been shown to improve antibiotic appropriateness prescriptions in some populations, so prescriptions are being issued, but only for what people truly need.  In HealthRight’s scheme, patients were prescribed drugs for ailments including stomach problems and joint pain that were selected on their profitability and not their effectiveness.  Patients would provide insurance information over the phone and be prescribed drugs they either didn’t need, were overpriced, or under-regulated in partnership with the fraudulent pharmacies.

True Telemedicine

True telemedicine is not dangerous or dramatic like this scandal makes it appear.  It’s surprisingly simple: Continuity of care with trusted healthcare providers through increased access.  If you’re not familiar with telemedicine, there are many ways for it to work – here’s one example:

You have a sore throat, could be bronchitis, or maybe not.  You have a busy day ahead and it’s impossible to take time off and see the doctor.  Fortunately, the doctor has a telemedicine practice implemented. Once the virtual appointment time comes, you connect with the doctor face-to-face via the camera.  They request a few images of your throat, walk you through a few questions, and possibly write a prescription. In minutes, you’re done and on with your day. Yes, it really is that easy.

Doctors and care teams work with patients daily through virtual solutions to optimize care.  This allows them to combine care specialties with behavioral health integration or chronic care management.  Diabetic patients, for example, benefit from not having to make multiple trips in and out of doctor’s offices.  Instead, physicians can make medication adjustments based on remote monitoring and brief check-in visits with patients, quickly and easily.

Healthcare’s Future Includes Virtual Care

There is an unfortunate reality in any industry, that someone will always try to take advantage of a changing environment.  However, most telemedicine providers are legitimate and have the best interest of the consumer in mind. Consumers should remember though, that if something sounds suspicious, to trust their gut.  Particularly in telemedicine, consumers have the right to direct care and full transparency from the provider and are entitled to care past a phone call.

Healthcare has traditionally been an industry that is slow to change, but the patient consumer is expecting a healthcare experience that mirrors other their other consumer environments.  This evolution in society will continue to push boundaries in healthcare, which needs to be done securely. Partnering with a HIPAA compliant platform is one of the easiest ways to bridge the gap.  Conducting secure video exams helps simulate an in-person office visit, with an online waiting room, quick referral management, and easy-to-use scheduling. These are core Visuwell features that transition patients to a successful virtual experience that also streamlines existing workflows.  To learn how VisuWell can positively impact your patient experience, contact us for more information.