On July 20, 2022, the U.S. Division of Well being and Human Providers’ Workplace of Inspector Basic (OIG) issued a Particular Fraud Alert warning physicians and different practitioners to train warning when coming into into telemedicine preparations which have sure suspect traits.
Based mostly on each the OIG’s and the Division of Justice’s experiences in bringing fraud and abuse enforcement actions, the OIG recognized the next traits as suspect:
- The sufferers for whom the doctor/practitioner orders or prescribes objects or companies are recognized or recruited by the telemedicine firm, telemarketing firm, gross sales agent, recruiter, name heart, well being truthful, and/or by means of web, tv, or social media promoting totally free or low out-of-pocket value objects or companies.
- The doctor/practitioner doesn’t have adequate contact with or info from the affected person to meaningfully assess the medical necessity of the objects or companies ordered or prescribed.
- The telemedicine firm compensates the doctor/practitioner based mostly on the quantity of things or companies ordered or prescribed, which can be based mostly on the variety of purported medical data that the doctor/practitioner reviewed.
- The telemedicine firm solely furnishes objects and companies to Federal well being care program beneficiaries and doesn’t settle for insurance coverage from another payor.
- The telemedicine firm claims to solely furnish objects and companies to people who usually are not Federal well being care program beneficiaries, however could in truth invoice Federal well being care applications.
- The telemedicine firm solely furnishes one product or a single class of merchandise (e.g., sturdy medical gear, genetic testing, diabetic provides, or varied prescription lotions), doubtlessly proscribing a doctor/practitioner’s treating choices to a predetermined course of therapy.
Physicians and practitioners who change into concerned with suspect telemedicine preparations are in danger for civil, prison and administrative legal responsibility for accepting unlawful kickbacks and submitting or inflicting to be submitted false claims to Federal well being care applications.
The OIG’s Particular Fraud Alert was issued the identical day that the Division of Justice introduced a nationwide enforcement motion that levied prison fees towards 36 defendants in 13 cities throughout the U.S., for greater than $1.2 billion in alleged fraudulent telemedicine schemes. The investigation primarily focused alleged funds of unlawful kickbacks and bribes by laboratory house owners and operators in trade for the referral of sufferers by medical professionals working with telemedicine and digital medical know-how firms. In response to the DOJ, telemedicine schemes accounted for greater than $1 billion of the $1.2 billion in losses related to this enforcement motion.
If you’re a doctor or practitioner concerned with a telemedicine firm, or are considering coming into into such an association, we urge you to fastidiously think about the OIG’s warning and search authorized counsel to make sure compliance. For those who want help, we’re right here to assist.