On July 20, 2022, the OIG launched a encouraging practitioners to train warning when coming into into preparations with telemedicine corporations, given the varied 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 will not be exhaustive and anybody issue will not be determinative of whether or not an association would violate the legislation.

1. Sufferers are recognized or recruited by commercials totally free or low out-of-pocket price objects or service by the telemedicine firm, gross sales agent, recruiter, name middle or well being truthful and/or via the web, tv, or social media.
2. 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 companies such practitioner orders or prescribes.
3. The telemedicine firm truly compensates the practitioner primarily based on the quantity of things or companies ordered or prescribed though the compensation association  could also be characterised to the practitioner as compensation primarily based on the variety of purported medical data the practitioner reviewed. 
4. The telemedicine firm solely furnishes objects and companies to federal well being care program beneficiaries and doesn’t settle for insurance coverage from every other payor.
5. The telemedicine firm payments federal well being care applications though it claims to solely furnish objects and companies to people who will not be federal well being care program beneficiaries.
6. The telemedicine firm solely furnishes one product or a single class of merchandise (e.g., sturdy medical tools, genetic testing, or different particular objects or companies) doubtlessly limiting the contracted practitioner’s treating choices to a predetermined course of remedy. 
7. The telemedicine firm doesn’t count on, nor present info to allow, practitioners to comply with up with sufferers. 

Whereas telemedicine fraud schemes range in design in operation, one frequent factor is utilizing kickbacks to aggressively recruit and reward practitioners. In lots of preparations, telemedicine corporations pays practitioners in change for ordering or prescribing objects and companies 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 must contact the affected person and could also be denied the chance to evaluate the medical data. Notably this raises concern over (1) a rise in price to federal well being care applications for medically pointless objects and companies; (2) the supply of pointless care which will hurt a affected person or delay wanted care; and (3) corrupt impartial medical decision-making. The Fraud Alert reminds practitioners that they might be personally answerable for these preparations if they’re concerned within the ordering or prescribing of medically pointless objects or companies. 

The OIG acknowledges that many practitioners have appropriately used telehealth companies over the course of the COVID-19 pandemic to offer medically mandatory 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 dealing with 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.

 is a associate in Thompson Coburn’s Well being Legislation Observe Group.   is an affiliate in Thompson Coburn’s Well being Legislation Observe Group.