A telehealth firm that offered psychological well being providers by means of video appointments admitted it billed Medicare and Medicaid for affected person appointments that by no means befell — and agreed to pay $300,000 to resolve the allegations.
The corporate, Aptihealth, Inc., and Aptihealth Medical, PLLC, relies in Clifton Park, New York. Based on the U.S. Division of Justice’s announcement on June 23, 2026, the settlement resolves False Claims Act allegations that included billing for affected person appointments the place sufferers didn’t present up, billing for affected person messages with out regard as to if these communications concerned billable medical content material, and billing for psychological testing providers that weren’t adequately documented.
Aptihealth additionally admitted to implementing a affected person incentive program involving $25 reward playing cards that the federal government contends violated the Anti-Kickback Statute.
Why This Issues
Telehealth psychological well being providers have reworked entry to psychiatric take care of hundreds of thousands of Individuals — lowering geographic limitations, eliminating transportation necessities, and increasing appointment availability for individuals who beforehand couldn’t entry care in any respect.
That progress has attracted fraudulent billing on a major scale. The DOJ’s 2026 Nationwide Well being Care Fraud Takedown, introduced concurrently with the Aptihealth settlement, charged 455 defendants — together with 90 licensed medical professionals — in reference to greater than $6.5 billion in alleged fraud. Telehealth and digital well being billing fraud have been particularly named as one of many takedown’s key targets, with 49 defendants charged in reference to $1.17 billion in allegedly fraudulent telehealth and genetic testing claims.
When telehealth corporations invoice for providers that by no means occurred, two harms outcome: the federal packages are defrauded, and sufferers might develop billing information that don’t precisely mirror their care historical past, with penalties for insurance coverage, incapacity claims, or future remedy.
What We Know So Far
Based on the DOJ announcement, Aptihealth’s billing violations included:
No-show billing: Submitting claims to Medicare and Medicaid for affected person appointments that didn’t happen as a result of the affected person didn’t attend.
Message billing: Billing for responses to affected person messages with out figuring out whether or not these communications concerned clinically billable content material.
Documentation failures: Billing for psychological testing providers with out adequate documentation to assist the claims.
Anti-Kickback violation: Providing $25 reward playing cards to sufferers who attended remedy classes — a monetary incentive that the federal government decided violated the Anti-Kickback Statute as a result of it may improperly affect sufferers’ selections to make use of the service.
Compliance program failures: Aptihealth’s compliance program didn’t meet New York statutory necessities for billing oversight, compliance monitoring, and coaching.
The settlement was filed as a whistleblower motion by a former Aptihealth worker below the False Claims Act’s qui tam provisions. The whistleblower will obtain roughly $51,000 of the settlement proceeds.
Not an Remoted Case
The Aptihealth settlement is among the smaller circumstances within the 2026 Nationwide Well being Care Fraud Takedown, however it illustrates a fraud sample that investigators say is systemic within the telehealth sector.
Based on the DOJ’s Fraud Division, the most important telehealth fraud case within the takedown was United States v. Blackman, involving Brett Blackman, founder and CEO of HealthSplash. His firm, DMERx, used overseas name facilities to blast spam to Medicare beneficiaries, pressuring aged sufferers to just accept medically pointless orthotic braces. The fraud concerned $1 billion in allegedly fraudulent Medicare claims for tools that, in lots of circumstances, was by no means ordered by a respectable doctor or wanted by the affected person.
The Southern District of Florida takedown included prices in opposition to 12 defendants in reference to greater than $4 billion in allegedly fraudulent claims for group psychological well being providers, amongst different classes, illustrating the dimensions at which telehealth billing fraud now operates.
What the Proof Exhibits — and What It Does Not
The Aptihealth settlement entails admitted conduct — the corporate admitted duty for the billing practices described. This can be a settlement, not a jury trial verdict, and the $300,000 fee just isn’t described as encompassing the complete quantity billed improperly. Settlement quantities in False Claims Act circumstances usually don’t symbolize the complete extent of alleged fraud.
The DOJ’s 2026 Takedown knowledge symbolize alleged fraud that has been charged or settled, not a complete image of the overall quantity of telehealth billing irregularities which will exist available in the market. Consultants in well being care fraud have famous that telehealth billing is especially tough to observe in actual time as a result of digital care happens with out the bodily presence of oversight, and documentation requirements range broadly.
Who Is Most Affected?
Medicaid and Medicare beneficiaries who acquired psychological well being providers by means of telehealth platforms and will have claims of their information for classes they didn’t attend
Sufferers who have been billed for message-based consultations that didn’t meet the medical threshold for a billable service
Taxpayers and program beneficiaries usually, since telehealth billing fraud will increase prices borne by the Medicare and Medicaid belief funds
What You Can Do Now
When you obtain psychological well being providers by means of telehealth and are coated by Medicare or Medicaid, evaluation your Clarification of Advantages (EOB) or Medicare Abstract Discover fastidiously. Examine that each listed service date corresponds to an appointment you really attended.
When you see a declare for a session you didn’t have, contact your insurance coverage firm or 1-800-MEDICARE (1-800-633-4227) to report it.
When you obtain telehealth care, you have got the correct to ask your supplier for a duplicate of your billing information. These information ought to mirror solely providers that have been really offered.
Report suspected Medicare or Medicaid billing fraud to the HHS OIG Hotline at 1-800-HHS-TIPS (1-800-447-8477).
When you work for a telehealth firm and suspect fraudulent billing, the False Claims Act’s whistleblower provisions let you report it and, if the case leads to a restoration, obtain a portion of the settlement proceeds.
Value and Entry: What Sufferers Ought to Know
Sufferers whose Medicare or Medicaid information include claims for providers they didn’t obtain shouldn’t owe out-of-pocket prices for these fraudulent claims. If a co-payment or cost-sharing was collected for a session that didn’t happen, sufferers ought to request a refund from the supplier. If the supplier doesn’t reply, contact your insurance coverage plan or state Medicaid company.
Sufferers who’ve skilled real fraudulent billing shouldn’t discontinue telehealth psychological well being care on account of this fraud. The fraud drawback lies with the billing practices of particular suppliers, not with telehealth as a modality for delivering respectable psychological well being providers.
What Occurs Subsequent
The DOJ’s 2026 Nationwide Well being Care Fraud Takedown is ongoing, with extra enforcement actions anticipated. CMS has suspended billing privileges for 1,403 suppliers and revoked them for 1,079 extra as a part of the 2026 motion. A newly introduced Well being Care Fraud Knowledge Fusion Middle will deploy synthetic intelligence and cloud computing instruments to determine telehealth billing fraud patterns extra quickly. MedicalDaily will proceed monitoring enforcement actions within the telehealth sector.
The Backside Line
A telehealth psychological well being firm admitted it billed Medicare and Medicaid for appointments that by no means occurred, and the DOJ’s 2026 Nationwide Well being Care Fraud Takedown makes clear this isn’t an remoted case. Telehealth billing fraud is among the fastest-growing classes of well being care fraud. Sufferers who use telehealth for psychological well being care ought to evaluation their billing information usually, verify that each declare of their report corresponds to an precise appointment, and report any discrepancies promptly.
