On July 20, 2022, the OIG launched a Fraud Alert encouraging practitioners to train warning when getting into into preparations with telemedicine corporations, given the assorted fraud and abuse dangers related to such preparations, together with an elevated danger of fraudulent claims to Medicare, Medicaid, and different federal healthcare packages.
The Fraud Alert lists seven traits of suspect preparations. This listing shouldn’t be exhaustive and anyone issue shouldn’t be determinative of whether or not an association would violate the legislation.
- Sufferers are recognized or recruited by ads totally free or low out-of-pocket price objects or service by the telemedicine firm, gross sales agent, recruiter, name middle or well being honest and/or by the web, tv, or social media.
- The practitioner who’s contracted with the telemedicine firm doesn’t have ample contact with or data from the affected person to meaningfully assess the medical necessity of the objects or companies such practitioner orders or prescribes.
- The telemedicine firm truly compensates the practitioner primarily based on the quantity of things or companies ordered or prescribed though the compensation association could also be characterised to the practitioner as compensation primarily based on the variety of purported medical data the practitioner reviewed.
- The telemedicine firm solely furnishes objects and companies to federal well being care program beneficiaries and doesn’t settle for insurance coverage from every other payor.
- The telemedicine firm payments federal well being care packages despite the fact that it claims to solely furnish objects and companies to people who should not federal well being care program beneficiaries.
- The telemedicine firm solely furnishes one product or a single class of merchandise (e.g., sturdy medical tools, genetic testing, or different particular objects or companies) doubtlessly proscribing the contracted practitioner’s treating choices to a predetermined course of therapy.
- The telemedicine firm doesn’t anticipate, nor present data to allow, practitioners to comply with up with sufferers.
Whereas telemedicine fraud schemes differ in design in operation, one widespread ingredient is utilizing kickbacks to aggressively recruit and reward practitioners. In lots of preparations, telemedicine corporations can pay practitioners in alternate for ordering or prescribing objects and companies for sufferers which whom the practitioners have had little to no interplay and with out contemplating medical necessity. Telemedicine corporations will inform the practitioner they don’t have to contact the affected person and could also be denied the chance to assessment the medical data. Notably this raises concern over (1) a rise in price to federal well being care packages for medically pointless objects and companies; (2) the availability of pointless care which will hurt a affected person or delay wanted care; and (3) corrupt unbiased medical decision-making. The Fraud Alert reminds practitioners that they might be personally answerable for these preparations if they’re concerned within the ordering or prescribing of medically pointless objects or companies.
The OIG acknowledges that many practitioners have appropriately used telehealth companies over the course of the COVID-19 pandemic to supply medically essential care to their sufferers. Nonetheless, practitioners ought to take note of the above suspect traits previous to getting into into preparations with telemedicine corporations.
This Fraud Alert demonstrates telemedicine preparations are dealing with heightened scrutiny, and suppliers ought to train warning and consideration earlier than getting into into these preparations to make sure compliance with relevant fraud and abuse legal guidelines.
Nicole Jobe is a associate in Thompson Coburn’s Well being Legislation Observe Group. Catherine Feorene is an affiliate in Thompson Coburn’s Well being Legislation Observe Group.