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 applications.
The Fraud Alert lists seven traits of suspect preparations. This listing is just not exhaustive and anyone issue is just not determinative of whether or not an association would violate the legislation.
- Sufferers are recognized or recruited by commercials at no cost 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 by way of the web, tv, or social media.
- The practitioner who’s contracted with the telemedicine firm doesn’t have adequate contact with or info from the affected person to meaningfully assess the medical necessity of the objects or providers such practitioner orders or prescribes.
- The telemedicine firm really 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 data the practitioner reviewed.
- 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.
- The telemedicine firm payments federal well being care applications although it claims to solely furnish objects 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 objects or providers) doubtlessly proscribing 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 observe up with sufferers.
Whereas telemedicine fraud schemes fluctuate in design in operation, one frequent ingredient is utilizing kickbacks to aggressively recruit and reward practitioners. In lots of preparations, telemedicine corporations pays 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 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 value to federal well being care applications for medically pointless objects and providers; (2) the supply of pointless care that will hurt a affected person or delay wanted care; and (3) corrupt impartial 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 offer medically vital care to their sufferers. Nonetheless, 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 Apply Group. Catherine Feorene is an affiliate in Thompson Coburn’s Well being Regulation Apply Group.