A telehealth company that provided mental health services through video appointments admitted it billed Medicare and Medicaid for patient appointments that never took place — and agreed to pay $300,000 to resolve the allegations.
The company, Aptihealth, Inc., and Aptihealth Medical, PLLC, is based in Clifton Park, New York. According to the U.S. Department of Justice’s announcement on June 23, 2026, the settlement resolves False Claims Act allegations that included billing for patient appointments where patients did not show up, billing for patient messages without regard to whether those communications involved billable clinical content, and billing for psychological testing services that were not adequately documented.
Aptihealth also admitted to implementing a patient incentive program involving $25 gift cards that the government contends violated the Anti-Kickback Statute.
Why This Matters
Telehealth mental health services have transformed access to psychiatric care for millions of Americans — reducing geographic barriers, eliminating transportation requirements, and expanding appointment availability for people who previously could not access care at all.
That growth has attracted fraudulent billing on a significant scale. The DOJ’s 2026 National Health Care Fraud Takedown, announced simultaneously with the Aptihealth settlement, charged 455 defendants — including 90 licensed medical professionals — in connection with more than $6.5 billion in alleged fraud. Telehealth and digital health billing fraud were specifically named as one of the takedown’s key targets, with 49 defendants charged in connection with $1.17 billion in allegedly fraudulent telehealth and genetic testing claims.
When telehealth companies bill for services that never occurred, two harms result: the federal programs are defrauded, and patients may develop billing records that do not accurately reflect their care history, with consequences for insurance, disability claims, or future treatment.
What We Know So Far
According to the DOJ announcement, Aptihealth’s billing violations included:
- No-show billing: Submitting claims to Medicare and Medicaid for patient appointments that did not occur because the patient did not attend.
- Message billing: Billing for responses to patient messages without determining whether those communications involved clinically billable content.
- Documentation failures: Billing for psychological testing services without sufficient documentation to support the claims.
- Anti-Kickback violation: Offering $25 gift cards to patients who attended therapy sessions — a financial incentive that the government determined violated the Anti-Kickback Statute because it could improperly influence patients’ decisions to use the service.
- Compliance program failures: Aptihealth’s compliance program did not meet New York statutory requirements for billing oversight, compliance monitoring, and training.
The settlement was filed as a whistleblower action by a former Aptihealth employee under the False Claims Act’s qui tam provisions. The whistleblower will receive approximately $51,000 of the settlement proceeds.
Not an Isolated Case
The Aptihealth settlement is one of the smaller cases in the 2026 National Health Care Fraud Takedown, but it illustrates a fraud pattern that investigators say is systemic in the telehealth sector.
According to the DOJ’s Fraud Division, the largest telehealth fraud case in the takedown was United States v. Blackman, involving Brett Blackman, founder and CEO of HealthSplash. His company, DMERx, used foreign call centers to blast spam to Medicare beneficiaries, pressuring elderly patients to accept medically unnecessary orthotic braces. The fraud involved $1 billion in allegedly fraudulent Medicare claims for equipment that, in many cases, was never ordered by a legitimate physician or needed by the patient.
The Southern District of Florida takedown included charges against 12 defendants in connection with more than $4 billion in allegedly fraudulent claims for community mental health services, among other categories, illustrating the scale at which telehealth billing fraud now operates.
What the Evidence Shows — and What It Does Not
The Aptihealth settlement involves admitted conduct — the company admitted responsibility for the billing practices described. This is a settlement, not a jury trial verdict, and the $300,000 payment is not described as encompassing the full amount billed improperly. Settlement amounts in False Claims Act cases typically do not represent the full extent of alleged fraud.
The DOJ’s 2026 Takedown data represent alleged fraud that has been charged or settled, not a comprehensive picture of the total volume of telehealth billing irregularities that may exist in the market. Experts in health care fraud have noted that telehealth billing is particularly difficult to monitor in real time because virtual care occurs without the physical presence of oversight, and documentation standards vary widely.
Who Is Most Affected?
- Medicaid and Medicare beneficiaries who received mental health services through telehealth platforms and may have claims in their records for sessions they did not attend
- Patients who were billed for message-based consultations that did not meet the clinical threshold for a billable service
- Taxpayers and program beneficiaries generally, since telehealth billing fraud increases costs borne by the Medicare and Medicaid trust funds
What You Can Do Now
- If you receive mental health services through telehealth and are covered by Medicare or Medicaid, review your Explanation of Benefits (EOB) or Medicare Summary Notice carefully. Check that every listed service date corresponds to an appointment you actually attended.
- If you see a claim for a session you did not have, contact your insurance company or 1-800-MEDICARE (1-800-633-4227) to report it.
- If you receive telehealth care, you have the right to ask your provider for a copy of your billing records. These records should reflect only services that were actually provided.
- Report suspected Medicare or Medicaid billing fraud to the HHS OIG Hotline at 1-800-HHS-TIPS (1-800-447-8477).
- If you work for a telehealth company and suspect fraudulent billing, the False Claims Act’s whistleblower provisions allow you to report it and, if the case results in a recovery, receive a portion of the settlement proceeds.
Cost and Access: What Patients Should Know
Patients whose Medicare or Medicaid records contain claims for services they did not receive should not owe out-of-pocket costs for those fraudulent claims. If a co-payment or cost-sharing was collected for a session that did not occur, patients should request a refund from the provider. If the provider does not respond, contact your insurance plan or state Medicaid agency.
Patients who have experienced genuine fraudulent billing should not discontinue telehealth mental health care as a result of this fraud. The fraud problem lies with the billing practices of specific providers, not with telehealth as a modality for delivering legitimate mental health services.
What Happens Next
The DOJ’s 2026 National Health Care Fraud Takedown is ongoing, with additional enforcement actions expected. CMS has suspended billing privileges for 1,403 providers and revoked them for 1,079 more as part of the 2026 action. A newly announced Health Care Fraud Data Fusion Center will deploy artificial intelligence and cloud computing tools to identify telehealth billing fraud patterns more rapidly. MedicalDaily will continue tracking enforcement actions in the telehealth sector.
The Bottom Line
A telehealth mental health company admitted it billed Medicare and Medicaid for appointments that never happened, and the DOJ’s 2026 National Health Care Fraud Takedown makes clear this is not an isolated case. Telehealth billing fraud is one of the fastest-growing categories of health care fraud. Patients who use telehealth for mental health care should review their billing records regularly, confirm that every claim in their record corresponds to an actual appointment, and report any discrepancies promptly.
