- August 25, 2022
- Alerts
HHS-OIG Issues Telemedicine Special Fraud Alert
The Department of Health and Human Services, Office of the Inspector General (“OIG”) published a Special Fraud Alert regarding arrangements with telemedicine companies. According to the OIG, it investigated dozens of fraud schemes involving companies that purported to provide telehealth, telemedicine, or telemarketing services (collectively, “Telemedicine Companies”). The fraud schemes varied in design and operation and involved a wide range of different individuals and types of entities.
A common element of these schemes is the use of kickbacks to aggressively recruit and reward Practitioners for their participation. Under the fraud schemes, Telemedicine Companies often told Practitioners that they did not need to contact the purported patients or that they only need to speak to patients by telephone. Practitioners were not given an opportunity to review patients’ real medical records and they were directed to order or prescribe preselected items or services without considering medical necessity or clinical appropriateness.
The OIG advised Practitioners to exercise caution and use heightened scrutiny when entering into arrangements with Telemedicine Companies that have one or more of the following examples of suspect characteristics:
According to the Special Alert, the OIG and DOJ have investigated many fraud cases involving kickbacks from Telemedicine Companies to Practitioners, and Practitioners have been held liable under the Federal anti-kickback statute and the False Claims Act, among other Federal laws.
Knowledge of how to enter into legitimate arrangements with Telemedicine Companies and what characteristics should raise concerns is critical in the effort to minimize risk and avoid potential legal sanctions.
Should you have any questions regarding the above, please contact the Garfunkel Wild attorney with whom you regularly work, or contact us at info@garfunkelwild.com.
A common element of these schemes is the use of kickbacks to aggressively recruit and reward Practitioners for their participation. Under the fraud schemes, Telemedicine Companies often told Practitioners that they did not need to contact the purported patients or that they only need to speak to patients by telephone. Practitioners were not given an opportunity to review patients’ real medical records and they were directed to order or prescribe preselected items or services without considering medical necessity or clinical appropriateness.
The OIG advised Practitioners to exercise caution and use heightened scrutiny when entering into arrangements with Telemedicine Companies that have one or more of the following examples of suspect characteristics:
- The patients for whom the Practitioner orders or prescribes items or services were identified or recruited by the Telemedicine Company, telemarketing company, sales agent, recruiter, call center, health fair, and/or through internet, television, or social media advertising for free or low out-of-pocket cost items or services.
- The Practitioner does not have sufficient contact with or information from the patient to assess the medical necessity of the items or services ordered or prescribed.
- The Telemedicine Company compensates the Practitioner based on the volume of items or services ordered or prescribed, which may be characterized to the Practitioner as compensation based on the number of medical records that the Practitioner reviewed.
- The Telemedicine Company only furnishes items and services to Federal health care program beneficiaries and does not accept insurance from any other payor.
- The Telemedicine Company claims to only furnish items and services to individuals who are not Federal health care program beneficiaries but may in fact bill Federal health care programs.
- The Telemedicine Company only furnishes one product or a single class of products (e.g., durable medical equipment, genetic testing, diabetic supplies, or various prescription creams), potentially restricting a Practitioner’s treating options to a predetermined course of treatment.
- The Telemedicine Company does not expect Practitioners (or another Practitioner) to follow up with patients nor does it provide Practitioners with the information required to follow up (e.g., the Telemedicine Company does not require Practitioners to discuss genetic testing results with each patient).
According to the Special Alert, the OIG and DOJ have investigated many fraud cases involving kickbacks from Telemedicine Companies to Practitioners, and Practitioners have been held liable under the Federal anti-kickback statute and the False Claims Act, among other Federal laws.
Knowledge of how to enter into legitimate arrangements with Telemedicine Companies and what characteristics should raise concerns is critical in the effort to minimize risk and avoid potential legal sanctions.
* * * * *
Should you have any questions regarding the above, please contact the Garfunkel Wild attorney with whom you regularly work, or contact us at info@garfunkelwild.com.