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 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 record just isn’t exhaustive and anybody issue just isn’t determinative of whether or not an association would violate the regulation.

1. Sufferers are recognized or recruited by commercials without cost or low out-of-pocket value gadgets 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 ample contact with or info from the affected person to meaningfully assess the medical necessity of the gadgets or companies such practitioner orders or prescribes.
3. The telemedicine firm really compensates the practitioner primarily based on the amount 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 gadgets and companies to federal well being care program beneficiaries and doesn’t settle for insurance coverage from another payor.
5. The telemedicine firm payments federal well being care applications despite the fact that it claims to solely furnish gadgets and companies to people who aren’t federal well being care program beneficiaries.
6. The telemedicine firm solely furnishes one product or a single class of merchandise (e.g., sturdy medical gear, genetic testing, or different particular gadgets or companies) doubtlessly limiting the contracted practitioner’s treating choices to a predetermined course of remedy. 
7. The telemedicine firm doesn’t anticipate, nor present info to allow, practitioners to comply with up with sufferers. 

Whereas telemedicine fraud schemes range in design in operation, one widespread aspect is utilizing kickbacks to aggressively recruit and reward practitioners. In lots of preparations, telemedicine corporations pays practitioners in change for ordering or prescribing gadgets 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 overview the medical data. Notably this raises concern over (1) a rise in value to federal well being care applications for medically pointless gadgets and companies; (2) the availability 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 could be personally chargeable for these preparations if they’re concerned within the ordering or prescribing of medically pointless gadgets 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. Nevertheless, 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.

Nicole Jobe is a associate in Thompson Coburn’s Well being Regulation Apply Group. Catherine Feorene  is an affiliate in Thompson Coburn’s Well being Regulation Apply Group.