By: Christopher Parrella, Esq., CPC, CHC, CPCO

Parrella Health Law, Boston, MA

A Health Care Provider Defense and Compliance Firm

A recent $300,000 False Claims Act settlement involving Aptihealth should get the attention of every telehealth provider, behavioral health company, and digital health platform. The billing issues identified by the government are not exotic. They are the same operational problems payers routinely address through audits, claim denials, and overpayment demands. What makes this case different is that those familiar compliance failures were elevated into a federal False Claims Act settlement.

Aptihealth operated a behavioral health telehealth platform and billed Medicare and Medicaid for services delivered remotely. According to the U.S. Attorney’s Office, the company billed for appointments that never occurred because patients were no-shows. It also billed for responses to patient messages without determining whether the communication involved billable clinical content and billed psychological testing services that lacked sufficient documentation.

These are common telehealth compliance risks. No-show billing, unsupported portal-message claims, and weak testing documentation frequently appear in payer audits. Providers often view them as reimbursement disputes that may result in repayment. This settlement shows that the government may take a much more serious view when the conduct is repeated, systemic, or supported by evidence that the organization failed to build effective billing controls.

The no-show allegations are especially important. A scheduled appointment is not a rendered service. Telehealth platforms must be able to confirm that the patient appeared, the clinician participated, and the encounter met the requirements for the code billed. Automated scheduling records alone are not enough. If a claim is generated simply because an appointment remained on the calendar, the provider is exposed.  The message-billing issue is equally significant. Not every patient message, portal response, or brief communication qualifies as a reimbursable clinical service. Providers must distinguish administrative exchanges from billable evaluation and management. The documentation should establish the clinical substance of the communication, the work performed, and any applicable time requirement.

The settlement also involved psychological testing services that were not sufficiently documented. Behavioral health providers should treat testing as a high-risk service line because payers routinely examine medical necessity, test administration, interpretation, scoring, and the qualifications of the individual performing each component.

Aptihealth also used a limited incentive program in which certain patients received a $25 gift card after attending therapy. The government alleged that the arrangement violated the Anti-Kickback Statute by creating artificial demand for federally reimbursable services. Even small patient incentives can create risk when they are tied directly to attendance or utilization.

The case began with a former employee’s whistleblower lawsuit. The relator will receive approximately $51,000 from the settlement. That is another reminder that telehealth billing weaknesses are often visible to clinicians, coders, and operational staff long before leadership addresses them. 

The call to action is straightforward. Telehealth providers should audit no-show claims, portal-message billing, psychological testing, and patient incentive programs now. Confirm that claims match actual encounters, documentation supports the code, and compliance staff are actively monitoring billing patterns. These issues may still begin as payer overpayments, but they can now end as False Claims Act settlements.

If you have questions about telehealth billing, behavioral health compliance, or False Claims Act exposure, please contact Parrella Health Law at 857.328.0382 or Chris directly at cparrella@parrellahealthlaw.com.