The Department of Health and Human Services Office of Inspector General issued an alert earlier this year warning physicians of potential fraud schemes when engaging with telemedicine companies. Kathleen Westfall discusses the seven “suspect characteristics” that could suggest risk of fraud and abuse in the latest issue of the Detroit Medical News.
It is no surprise that the use of telemedicine as a means of providing patients with access to medical care has increased significantly in recent years. Likewise, the number of telemedicine companies offering a broad range of health care items and services through physician and nonphysician practitioners has also increased significantly. On July 20, 2022, the United States Department of Health and Human Services Office of Inspector General (OIG) issued a Special Fraud Alert warning physicians and other practitioners to exercise caution when entering into arrangements with telemedicine companies.
The Alert is in response to dozens of OIG investigations of fraud schemes involving telemedicine and other companies that purported to provide telemedicine, telehealth, or telemarketing services. Although the fraud schemes vary in design and operation and involve a wide range of different individuals and types of entities, the Alert explains that one common element of the schemes is the way the telemedicine companies have used kickbacks to reward physicians and nonphysicians (collectively, “Practitioners”) to further the fraud schemes. Specifically, the telemedicine companies will generally arrange with Practitioners to order or prescribe medically unnecessary items and services for individuals who are solicited and recruited by telemedicine companies. Often, the Practitioners are paid to order or prescribe items or services (1) to patients with whom the Practitioners have limited, if any, interaction, and (2) without regard to medical necessity.
To assist Practitioners, the Alert identifies a list of seven “suspect characteristics” related to Practitioner arrangements with telemedicine companies which could suggest an arrangement that presents a heightened risk of fraud and abuse.
For the complete list, read Kathleen’s full article on page 18 in the Third Quarter 2022 edition of the Detroit Medical News.
Kathleen A. Westfall maintains a business practice focused primarily on helping clients to navigate complex licensing and regulatory issues related to state and federal health care laws and regulations. She assists health care clients with a number of corporate and contractual issues and disputes, including third party payor audits, insurance coverage matters, and reviewing, drafting and negotiating various contractual agreements. She also represents health care professionals and facilities in connection with licensing investigations and other enforcement actions by state and federal agencies.
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