On July 20, 2022, the U.S. Division of Well being and Human Companies’ Workplace of Inspector Normal (OIG) issued a Particular Fraud Alert [Special Fraud Alert–Telefraud (hhs.gov)] 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 gadgets or providers are recognized or recruited by the telemedicine firm, telemarketing firm, gross sales agent, recruiter, name middle, well being honest, and/or by way of web, tv, or social media promoting without cost or low out-of-pocket value gadgets or providers.
- The doctor/practitioner doesn’t have ample contact with or data from the affected person to meaningfully assess the medical necessity of the gadgets or providers ordered or prescribed.
- The telemedicine firm compensates the doctor/practitioner primarily based on the amount of things or providers ordered or prescribed, which can be primarily based on the variety of purported medical information that the doctor/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 some other payor.
- The telemedicine firm claims to solely furnish gadgets and providers to people who should not Federal well being care program beneficiaries, however could in actual fact invoice Federal well being care packages.
- The telemedicine firm solely furnishes one product or a single class of merchandise (e.g., sturdy medical tools, genetic testing, diabetic provides, or varied prescription lotions), probably proscribing a doctor/practitioner’s treating choices to a predetermined course of remedy.
Physicians and practitioners who turn 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 packages.
The OIG’s Particular Fraud Alert was issued the identical day that the Division of Justice introduced a nationwide enforcement motion that levied prison expenses towards 36 defendants in 13 cities throughout the U.S., for greater than $1.2 billion in alleged fraudulent telemedicine schemes. [Justice Department Charges Dozens for $1.2 Billion in Health Care Fraud | OPA | Department of Justice] The investigation primarily focused alleged funds of unlawful kickbacks and bribes by laboratory homeowners and operators in change for the referral of sufferers by medical professionals working with telemedicine and digital medical know-how corporations. Based on 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 rigorously think about the OIG’s warning and search authorized counsel to make sure compliance. Should you want help, we’re right here to assist.