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 threat of fraudulent claims to Medicare, Medicaid, and different federal healthcare packages.
The Fraud Alert lists seven traits of suspect preparations. This record shouldn’t be exhaustive and anybody issue shouldn’t be determinative of whether or not an association would violate the legislation.
- Sufferers are recognized or recruited by commercials without cost or low out-of-pocket price gadgets or service by the telemedicine firm, gross sales agent, recruiter, name middle or well being honest and/or by way of the web, tv, or social media.
- 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 gadgets or providers such practitioner orders or prescribes.
- The telemedicine firm truly 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 gadgets 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 packages regardless that it claims to solely furnish gadgets 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 tools, genetic testing, or different particular gadgets or providers) probably proscribing the contracted practitioner’s treating choices to a predetermined course of remedy.
- The telemedicine firm doesn’t count on, nor present info to allow, practitioners to comply with up with sufferers.
Whereas telemedicine fraud schemes differ in design in operation, one frequent factor is utilizing kickbacks to aggressively recruit and reward practitioners. In lots of preparations, telemedicine corporations can pay practitioners in trade for ordering or prescribing gadgets 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 price to federal well being care packages for medically pointless gadgets and providers; (2) the availability of pointless care that will hurt a affected person or delay wanted care; and (3) corrupt unbiased medical decision-making. The Fraud Alert reminds practitioners that they might be personally responsible for these preparations if they’re concerned within the ordering or prescribing of medically pointless gadgets 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.