Virginia Board of Medicine Section Three: Guidelines for the Appropriate Use of telemedicine Services. From the previous document on your website:

Guidance document: 85-12 Revised: October 28, 2018 it states: 
The Board has adopted the following guidelines for practitioners utilizing telemedicine services
in the delivery of patient care, regardless of an existing practitioner-patient relationship prior to
an encounter.  Licensure: The practice of medicine occurs where the patient is located at the time telemedicine services are used, and insurers may issue reimbursements based on where the practitioner is located.
Therefore, a practitioner must be licensed by, or under the jurisdiction of, the regulatory board of the state where the patient is located and the state where the practitioner is located. Practitioners who treat or prescribe through online service sites must possess appropriate licensure in all jurisdictions where patients receive care. To ensure appropriate insurance coverage, practitioners must make certain that they are compliant with federal and state laws and policies regarding reimbursements.  ( Please note here that there is no clause to discourage abuse of “compliant with federal and state laws” of this last sentence).

The Agency Regulatory Coordinator, Ms. Yeates, referred me to the “ About the Board News Section” of the Health Professions Board of Medicine for Virginia. The title of the news was ‘relaxation for HHS enforcement of HIPAA for telehealth’ during the pandemic. The related links did not cover the problem that I am having with Telemedicine.

People are not paying attention to a serious problem that has arisen in Virginia and nationally, since so many people started using Telemedicine. I greatly appreciate the attempt of the Virginia Board of Medicine to implement a telemedicine guideline. However, there is one huge loophole. While Regulations are created, there appears to be No Enforcement for violations.

Everyone is assuming that individual practitioners are compliant with the NPI registration for primary practice addresses while they are billing insurance for teletherapy at home.

In my situation, my business office, where I hold the lease and pay commercial office rent and sublet to two therapists, was fraudulently used for insurance billing. The therapist who rented a room abandoned their lease in November 2020. The person had been paying a small amount of rent for the previous 10 months while conducting teletherapy from home. It was okay for the person to use the office address as a tenant who paid rent, but after the person left it was not.

 We knew what the person was doing, the person was going to work from home and bill insurance for all their counseling services while continuing to use my office address as an NPI registered primary practice address. Over two months, we wrote 3 certified letters to her, asking the person to stop using my office address. The person did not. We reluctantly thought that the Board of Social Work would stop the person under their listed clause that states ‘ Shall not use misleading or false advertising’. Their response was to me that I would have to take the person to court to make him/her stop. There was absolutely no attempt by the Social Work board to send the person a letter telling the person to stop false and misleading advertising about telemedicine.

This  person was billing major insurance carriers for thousands of dollars each month, while fraudulently using my address. I realized how easy it is to manipulate this system. Just go rent an office for a month, make some scene to intimidate your landlord, abandon the lease (after you have set up the NPI registry) and then go home and fraudulently bill for teletherapy while not paying rent.

I was very disappointed that the Social Work board would tell me that I had to pay money to take this person to court. I had already spent about 40 dollars writing certified cease and desist letters which were ignored.

That was in February, 2021. Since that time, we watched while the person left up the map location of my office on her Facebook page and continued to advertise on Psychology Today and the Central Virginia Network that he/she was at my office address.  Even today, August 18, almost 9 months after the person left the office, the person is still using my my office address on the Anthem, Aetna, Cigna and Kaiser professional in network provider referral sites. My office is listed as person's primary practice address. I had to ask friends to log into their insurance networks to see this information as it is not visible to the public unless you are an insurance subscriber. The person was using an obsolete name on the NPI registry, so it did not register the name that he/she uses in Virginia. That made it harder to track my office address. It wasn’t just the fake name or my fake office address. The person was using a previous address from NYC as the secondary practice address. That address was linked to Medicare and Medicaid numbers.

We contacted the NPI Registry to file a complaint. We were told that they don’t do any enforcement.  They said that only the NPI registered person can update their information.  However, on the NPI registration page it says the following from the link:

https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS10114.pdf

Penalties for Falsifying Information on the National Provider Identifier (NPI) Application/Update Form
18 U.S.C. 1001 authorizes criminal penalties against an individual who in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals or covers up by any trick, scheme or device a material fact, or makes any false, fictitious or fraudulent statements or representations, or makes any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry. Individual offenders are subject to fines of up to $250,000 and imprisonment for up to 5 years. Offenders that are organizations are subject to fines of up to $500,000. 18 U.S.C. 3571(d) also authorizes fines of up to twice the gross gain derived by the offender if it is greater than the amount specifically authorized by the sentencing statute

As you can see, there are regulations regarding NPI Fraud. Their website states that any changes must be updated within 30 days. But they have no enforcement division.

Then we contacted Medicare Fraud of Virginia. They don’t take every case, but they took this one. They had me mail a large amount of paperwork to their office ( more money in postage and copies). Then I received a letter from HHS stating that they are too understaffed to write a letter to one person.

Finally, out of complete desperation, we did what the Social Work Board said, and I filed in small claims court in VA. That cost another 75 dollars.  I asked for the person to stop the false advertising and pay damages in the amount of 2000 dollars for using the office address illegally for 7 months. It was listed as a small claim in the ‘under 5000 dollars’ court. The person hired a trial attorney to intimidate me. He bumped it up to the general circuit court where I would have to face off with a trial attorney and it was intimidating. Further, the person's elderly father then called me and threatened me with ‘great harm’ if I did not drop the claim. He had no idea what his adult child was doing with illegal insurance billing. We had to file a police report concerning that encounter.

I am just a health care worker myself. But I am honest. I would never lie on my NPI registration for insurance reimbursement. I was scared. So, I dropped the case. I can look online today on Anthem, Aetna, Cigna or Kaiser and see the person still using a fake name and my office address as a primary physical address for telemedicine insurance billing. My office address has been embedded in hundreds of insurance claims over the past 9 months.

 It is so clear that it is way too easy to  create a fraudulent insurance billing scam. Given the lack of enforcement from the VA Social Work Board, the NPI Registry and the overburdened HHS, this is one of the easiest forms of fraud out there.   A few years ago, the Government Accountability Office conducted research in which they found a large percentage of fraud with the NPI registry.

Even a month after we dropped the case, this person continues to advertise on the NPI registry that my office is him/her primary practice address. We finally shelled out another 50 dollars for certified postage and reported the person directly to the 4 major insurance agencies. We issued Cease and Desist letters to Anthem, Aetna, Cigna and Kaiser. I was contacted by their fraud divisions, who took at the information and documentation and told me that it is their policy never to discuss the outcome of the fraud investigation with the person who files the complaint. I have yet to see any changes on the NPI registry or their individual subscriber log in websites. They don’t seem to have any control over the lack of enforcement at the NPI either.

The conclusion here is that the Virginia Board of Medicine is really keeping their eyes closed about this telemedicine fraud problem. There is regulation. But zero enforcement. NPI is no help. It should be mandatory in Virginia that the telemedicine section under consideration here has an additional clause that states: if fraud is suspected in Virginia concerning telemedicine false use of primary physical addresses through the NPI Registry ( which all the major carriers also state should not contain false information),  or false and misleading advertising relating to telemedicine, the a person can file a complaint with the individual boards involved and have them contact the person to make them stop.  

I think the Board of Social Work needs to reconsider their stance on false and misleading advertising as it relates to telemedicine fraud. I hope they read this, or Ms. Yeates directs this comment to them to review for the Board of Medicine telemedicine guidelines.

This kind of fraud is too easy to commit. The problem is that the State and Federal Government agencies are not stopping it if someone has a valid complaint.