On July 20, 2022, the OIG launched a Fraud Alert encouraging practitioners to train warning when coming into into preparations with telemedicine firms, 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 applications.
The Fraud Alert lists seven traits of suspect preparations. This record 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 value gadgets or service by the telemedicine firm, gross sales agent, recruiter, name heart or well being honest and/or by means of the web, tv, or social media.
- 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 gadgets or providers such practitioner orders or prescribes.
- The telemedicine firm truly compensates the practitioner primarily based on the amount 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.
- The telemedicine firm solely furnishes gadgets and providers 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 applications despite the fact that it claims to solely furnish gadgets and providers to people who are usually 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) doubtlessly limiting 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 factor is utilizing kickbacks to aggressively recruit and reward practitioners. In lots of preparations, telemedicine firms can pay practitioners in alternate 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 firms will inform the practitioner they don’t must contact the affected person and could also be denied the chance to evaluation the medical data. Notably this raises concern over (1) a rise in value to federal well being care applications 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 chargeable 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 offer medically needed care to their sufferers. Nonetheless, practitioners ought to take note of the above suspect traits previous to coming 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 coming 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 Regulation Follow Group. Catherine Feorene is an affiliate in Thompson Coburn’s Well being Regulation Follow Group.