Telemedicine Special Fraud Alert

The US Office of Inspector General (OIG) released another in a series of Special Fraud Alerts on July 20, 2022, this one directed to potentially fraudulent telehealth, telemedicine, and telemarketing service fraud schemes, collectively referred to as “Telemedicine Companies”.  The alert is based upon OIG’s perception that these Telemedicine Companies are engaged in schemes to pay kickbacks to practitioners to generate fraudulent orders for medical services, specifically:

• Durable medical equipment
• Genetic testing
• Wound care items
• Prescription medications

The Alert states that “telemedicine companies have used kickbacks to aggressively recruit and reward practitioners to prescribe items or services for”:

1. Purported patients with which the practitioners have limited, if any interaction
2. Prescribed items or services without regard to medical necessity”

The Alert goes on to identify common characteristics of fraudulent telemedicine company schemes, i.e.

• The purported patients are identified and/or recruited by the Telemedicine Companies through a variety of means and then presented to the practitioners
• Lack of sufficient contact or information to meaningfully assess medical necessity
• Payment based upon the volume of items or services ordered or prescribed
• The patient groups are limited to one category of third party payor, either only through a healthcare program or excluding federal healthcare programs
• The telemedicine company furnishes only “one product or service”

The Alert also footnotes a list of prior alerts, prior investigations, and prior prosecutions.

For more information on this, contact Mike Cassidy at mcassidy@tuckerlaw.com, (412) 594-5515. You can also visit our Med Law Blog here.