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HomeHealth LawOIG points fraud alert warning practitioners of dangers with telemedicine preparations

OIG points fraud alert warning practitioners of dangers with telemedicine preparations


On July 20, 2022, the OIG launched a Fraud Alert encouraging practitioners to train warning when coming into into preparations with telemedicine firms, 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 isn’t exhaustive and anybody issue isn’t determinative of whether or not an association would violate the legislation.

  1. Sufferers are recognized or recruited by ads free of charge or low out-of-pocket price gadgets or service by the telemedicine firm, gross sales agent, recruiter, name middle or well being truthful and/or by the web, tv, or social media.
  2. The practitioner who’s contracted with the telemedicine firm doesn’t have adequate contact with or data from the affected person to meaningfully assess the medical necessity of the gadgets or providers such practitioner orders or prescribes.
  3. The telemedicine firm really compensates the practitioner primarily based on the quantity of things or providers ordered or prescribed though the compensation association  could also be characterised to the practitioner as compensation primarily based on the variety of purported medical information the practitioner reviewed. 
  4. The telemedicine firm solely furnishes gadgets and providers 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 packages despite the fact that it claims to solely furnish gadgets and providers 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 gadgets or providers) probably limiting the contracted practitioner’s treating choices to a predetermined course of remedy. 
  7. The telemedicine firm doesn’t anticipate, nor present data to allow, practitioners to observe up with sufferers. 

Whereas telemedicine fraud schemes range in design in operation, one widespread factor is utilizing kickbacks to aggressively recruit and reward practitioners. In lots of preparations, telemedicine firms pays practitioners in change 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 firms will inform the practitioner they don’t have to contact the affected person and could also be denied the chance to overview the medical information. Notably this raises concern over (1) a rise in price to federal well being care packages for medically pointless gadgets and providers; (2) the supply of pointless care that 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 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 mandatory care to their sufferers. Nevertheless, practitioners ought to take note of the above suspect traits previous to coming into into preparations with telemedicine firms. 

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.

Nicole Jobe is a companion in Thompson Coburn’s Well being Legislation Follow Group. Catherine Feorene  is an affiliate in Thompson Coburn’s Well being Legislation Follow Group.

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