How to Combat Telehealth Fraud: 5 Smart Actions to Take 

Not long ago, telehealth adoption amidst COVID-19 soared–seemingly overnight—and continues to be mainstream. Now, unfortunately, telehealth fraud is, too.

The number of data breaches have soared since the beginning of the pandemic. In fact, 2022 was the second-worst year ever regarding the number of reported data breaches—only to be topped by 2021. 

Increased digital connections and communications in healthcare translates into increased audit and financial risks as well. 

Organizations that adopt and use telehealth must remain continuously aware of how doing so opens them up to abuse, fraud, human-driven errors, and waste. It is critical to rapidly respond to regulatory shifts, maintain audit readiness, identify risks, and so on. This way, you can be prepared to act urgently and effectively should telehealth fraud occur or telehealth-related risks arise. 

Preparation, awareness, and having the right tools in place are key. Below is a short blueprint highlighting five urgent telehealth-focused action items your organization should incorporate and adopt today to be prepared tomorrow: 

Five Ways to Mitigate Telehealth Fraud 

1. Focus on operational resilience amidst fraud threats

Pay close and careful attention to how the regulatory landscape continues to evolve. Concurrently, build frameworks across your organization that focus on the interconnectedness of ongoing risk. 

Implement a strong Information Technology (IT) risk management program. This will help ensure, for instance, your healthcare entity avoids fines associated with non-compliance of Health Insurance Portability and Accountability Act (HIPAA) or the Health Information Technology for Economic and Clinical Health (HITECH) Act. 

2. Have a robust compliance plan in place to address potential fraud

Hospitals wanting to win over regulators while experiencing revenue growth and increasing levels of patient trust must focus on preparation. 

Implement training for your employees and contractors sooner than later. If you already have this in place, ensure it remains updated. This way, everyone involved in the organization knows the details of your IT Security program.  

From the dangers of opening up and clicking a link within a phishing email to not securing a password according to best practices, it is important employees remain acutely aware of how to improve their daily work habits to maximize safety and minimize risk short-term and long-term for everyone around them. 

3. Be able to seamlessly demonstrate telehealth fraud prevention efforts to regulators 

Healthcare entities should require any telemedicine partners they plan to work with undergo a detailed background check. Doing so will help decrease the chance of fraud and mitigate any associated penalties. 

4. Address third-party telehealth risks

This work includes assessing third-party security programs, communicating effectively with business associates to ensure they are aware of your IT risk policies, and completing ongoing assessments and audits. 

5. Implement an easy-to-use, configurable, streamlined healthcare compliance solution

The SAI360 platform is a comprehensive solution that takes a multi-faceted approach to preventing and detecting telehealth fraud and abuse. Just a few of SAI360’s built-in telehealth and fraud mitigation benefits include helping organizations: 

• Keep policies managed and well-organized 
• Respond quickly to regulatory changes 
• Conduct assessments and remain audit-ready 
• Streamline incident reporting and investigation management 
• Maintain revenue integrity and know risks up-front 
• Proactively identify potential risks with vendors and service providers 
• Access an anonymous personal ethics hotline number to address complaints 

For more information on how SAI360’s modular SaaS solutions can drive efficiency, efficacy, and agility in your workplace, visit https://www.sai360.com/industries/healthcare-health-insurance.