Those who would resist any attempts to promote further development of telemedicine are always looking for ways to portray it as a bad thing. Telemedicine critics spare no expense to find flaws and magnify them. Rarely are other problems explored in depth. Take ongoing CMS ineptitude.
Known officially as the Centers for Medicare and Medicaid Services, CMS is ultimately responsible for administering both the Medicare and Medicaid programs. They are so influential in setting national healthcare policy that private insurance carriers almost always mimic what they do.
Unfortunately, CMS and both public health insurance programs have a long history of ineptitude. So much so that if you shouldn’t be surprised to learn that billions of dollars in fraud have been perpetrated against CMS, through telemedicine solutions, since the COVID pandemic began. Who takes the blame? The telemedicine industry.
Blame the Tool, Not the User
Our modern culture has a bad habit of blaming tools rather than the users of said tools. We blame cell phones for a loss of social skills among young people. Yet it is the people who use cell phones that create the problem. The same is true in telemedicine fraud.
A recent Reuters article looking at telemedicine fraud during the pandemic references DOJ enforcement action involving some $1.2 billion in fraudulent claims. Some thirty-six defendants have been charged. Likewise, CMS has taken action against fifty-two service providers.
Although Reuters doesn’t come out and say it directly, the implication of the report is that telemedicine is to blame. As the thinking goes, utilizing telemedicine solutions makes it too easy to do from the government. This writer would humbly disagree. Government makes it too easy to defraud them by the way they do things.
Telemedicine Isn’t Alive
Telemedicine isn’t alive. At CSI Health in San Antonio, TX, they design and build a range of telehealth solutions. From medical kiosks to mobile telemedicine packs, CSI Health solutions are tools used by clinicians to provide healthcare services remotely. But it is the clinicians providing the services, not the machines.
On the other end of the spectrum are the people who work at CMS. Those at the top, who develop the policies by which CMS operates, are the same people who make the decisions about day-to-day operations. The CMS employs IT professionals, software developers, bureaucrats, and a full army of laborers who do the actual work.
If fraud is being perpetrated against CMS, would it be the responsibility of its army of workers to detect and defend against it? Absolutely. The fact that billions of dollars in fraudulent claims can make it through CMS is a testament to just how inept the agency is.
Not Alone in Its Ineptitude
Unfortunately, CMS is not alone in its ineptitude. Just do a Google search on misused COVID-19 payroll protection loans and you’ll see that, once again, billions of dollars were given out to fraudsters. Do another global search on disability fraud, unemployment benefits fraud, and on and on. Wherever you see government spending money, you see excessive amounts of fraud.
The private sector rarely sees fraud of this magnitude. Why? Because private sector companies are motivated to maximize profits. Fraud is the antithesis of the profit mindset. If companies are being defrauded, they are losing money.
No doubt that telemedicine was utilized to perpetrate fraud during the pandemic. The telemedicine isn’t the problem. It is the people behind the fraud – both those who committed and those who allow it – who should be blamed. Telemedicine is a tool. It is an inanimate object. It cannot facilitate fraud any more than a cell phone can crash your car.
