OIG points fraud alert warning practitioners of dangers with telemedicine preparations

On July 20, 2022, the OIG launched a Fraud Alert encouraging practitioners to train warning when getting into into preparations with telemedicine firms, 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 applications.

The Fraud Alert lists seven traits of suspect preparations. This record isn’t exhaustive and anybody issue isn’t determinative of whether or not an association would violate the legislation.

1. Sufferers are recognized or recruited by ads free of charge or low out-of-pocket value objects or service by the telemedicine firm, gross sales agent, recruiter, name heart or well being truthful and/or via the web, tv, or social media.
2. The practitioner who’s contracted with the telemedicine firm doesn’t have adequate contact with or data from the affected person to meaningfully assess the medical necessity of the objects or providers such practitioner orders or prescribes.
3. The telemedicine firm truly compensates the practitioner primarily based on the quantity of things or providers 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. 
4. The telemedicine firm solely furnishes objects and providers to federal well being care program beneficiaries and doesn’t settle for insurance coverage from some other payor.
5. The telemedicine firm payments federal well being care applications although it claims to solely furnish objects and providers to people who should not federal well being care program beneficiaries.
6. 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 providers) probably proscribing the contracted practitioner’s treating choices to a predetermined course of therapy. 
7. 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 frequent ingredient is utilizing kickbacks to aggressively recruit and reward practitioners. In lots of preparations, telemedicine firms can pay practitioners in trade for ordering or prescribing objects and providers for sufferers which whom the practitioners have had little to no interplay and with out contemplating medical necessity. Telemedicine firms will inform the practitioner they don’t have to contact the affected person and could also be denied the chance to evaluate the medical data. Notably this raises concern over (1) a rise in value to federal well being care applications for medically pointless objects and providers; (2) the availability of pointless care that 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 chargeable for these preparations if they’re concerned within the ordering or prescribing of medically pointless objects or providers. 

The OIG acknowledges that many practitioners have appropriately used telehealth providers over the course of the COVID-19 pandemic to offer 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 firms. 

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 companion in Thompson Coburn’s Well being Legislation Apply Group. Catherine Feorene  is an affiliate in Thompson Coburn’s Well being Legislation Apply Group.