On July 20, 2022, the OIG launched a Fraud Alert encouraging practitioners to train warning when getting 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 checklist shouldn’t be exhaustive and anybody issue shouldn’t be determinative of whether or not an association would violate the regulation.

1. Sufferers are recognized or recruited by commercials free of charge 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 by way of 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 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 data the practitioner reviewed. 
4. The telemedicine firm solely furnishes objects and providers to federal well being care program beneficiaries and doesn’t settle for insurance coverage from some other payor.
5. The telemedicine firm payments federal well being care packages regardless that it claims to solely furnish objects and providers 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 objects or providers) probably proscribing the contracted practitioner’s treating choices to a predetermined course of therapy. 
7. The telemedicine firm doesn’t count on, nor present info to allow, practitioners to observe up with sufferers. 

Whereas telemedicine fraud schemes fluctuate in design in operation, one widespread aspect is utilizing kickbacks to aggressively recruit and reward practitioners. In lots of preparations, telemedicine firms can pay practitioners in alternate for ordering or prescribing objects 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 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 price to federal well being care packages for medically pointless objects 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 could be personally answerable for these preparations if they’re concerned within the ordering or prescribing of medically pointless objects or providers. 

The OIG acknowledges that many practitioners have appropriately used telehealth providers over the course of the COVID-19 pandemic to supply medically needed care to their sufferers. Nonetheless, practitioners ought to take note of the above suspect traits previous to getting 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 getting into into these preparations to make sure compliance with relevant fraud and abuse legal guidelines.

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