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 varied 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 record just isn’t exhaustive and anybody issue just isn’t determinative of whether or not an association would violate the regulation.
- Sufferers are recognized or recruited by ads at no cost or low out-of-pocket price gadgets or service by the telemedicine firm, gross sales agent, recruiter, name middle or well being honest and/or by way of the web, tv, or social media.
- The practitioner who’s contracted with the telemedicine firm doesn’t have enough contact with or info from the affected person to meaningfully assess the medical necessity of the gadgets or providers such practitioner orders or prescribes.
- The telemedicine firm truly compensates the practitioner based mostly on the quantity of things or providers ordered or prescribed though the compensation association could also be characterised to the practitioner as compensation based mostly on the variety of purported medical information the practitioner reviewed.
- The telemedicine firm solely furnishes gadgets and providers to federal well being care program beneficiaries and doesn’t settle for insurance coverage from some other payor.
- The telemedicine firm payments federal well being care packages though it claims to solely furnish gadgets and providers to people who usually are not federal well being care program beneficiaries.
- The telemedicine firm solely furnishes one product or a single class of merchandise (e.g., sturdy medical gear, genetic testing, or different particular gadgets or providers) probably limiting the contracted practitioner’s treating choices to a predetermined course of therapy.
- The telemedicine firm doesn’t anticipate, nor present info to allow, practitioners to comply with up with sufferers.
Whereas telemedicine fraud schemes fluctuate in design in operation, one widespread factor is utilizing kickbacks to aggressively recruit and reward practitioners. In lots of preparations, telemedicine corporations pays practitioners in change for ordering or prescribing gadgets and providers 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 must contact the affected person and could also be denied the chance to assessment the medical information. Notably this raises concern over (1) a rise in price to federal well being care packages for medically pointless gadgets and providers; (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 could be personally responsible for these preparations if they’re concerned within the ordering or prescribing of medically pointless gadgets or providers.
The OIG acknowledges that many practitioners have appropriately used telehealth providers over the course of the COVID-19 pandemic to supply medically needed 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 accomplice in Thompson Coburn’s Well being Legislation Observe Group. Catherine Feorene is an affiliate in Thompson Coburn’s Well being Legislation Observe Group.
