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 coming 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 checklist will not be exhaustive and anybody issue will not be determinative of whether or not an association would violate the regulation.

1. Sufferers are recognized or recruited by ads without spending a dime or low out-of-pocket price objects or service by the telemedicine firm, gross sales agent, recruiter, name heart or well being truthful and/or by the web, tv, or social media.
2. 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 objects or providers such practitioner orders or prescribes.
3. 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 information 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 another payor.
5. The telemedicine firm payments federal well being care packages despite the fact that it claims to solely furnish objects and providers to people who are usually 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 gear, genetic testing, or different particular objects or providers) probably proscribing the contracted practitioner’s treating choices to a predetermined course of remedy. 
7. The telemedicine firm doesn’t count on, nor present info to allow, practitioners to observe up with sufferers. 

Whereas telemedicine fraud schemes differ in design in operation, one frequent component is utilizing kickbacks to aggressively recruit and reward practitioners. In lots of preparations, telemedicine corporations pays practitioners in change 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 corporations will inform the practitioner they don’t must contact the affected person and could also be denied the chance to overview the medical information. Notably this raises concern over (1) a rise in price to federal well being care packages for medically pointless objects and providers; (2) the supply 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 accountable 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 supply medically crucial care to their sufferers. Nevertheless, practitioners ought to take note of the above suspect traits previous to coming into into preparations with telemedicine corporations. 

This Fraud Alert demonstrates telemedicine preparations are going through 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 accomplice in Thompson Coburn’s Well being Regulation Observe Group. Catherine Feorene  is an affiliate in Thompson Coburn’s Well being Regulation Observe Group.