On July 20, the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) issued a new Special Fraud Alert (SFA) on practitioner arrangements with telehealth, telemedicine or telemarketing companies to warn the industry—particularly providers—about key characteristics of “telehealth fraud.” The SFA comes on the heels of a near-simultaneous DOJ $1.2 billion nationwide health care fraud takedown that targeted telemedicine companies in addition to clinical laboratories and durable medical equipment suppliers, and almost one year after a comparable DOJ takedown. These recent actions are the strongest indications yet of enforcement agencies’ increased focus on fraud and abuse in telemedicine arrangements given the rapid expansion of telehealth services over the past three years; however, the SFA notes that the alert’s intent is not to discourage “legitimate” telehealth arrangements.
The SFA highlights schemes where telemedicine companies recruit, engage and reward physician and nonphysician providers with kickbacks in exchange for such providers prescribing or ordering medically unnecessary durable medical equipment, genetic testing, wound care items or medications. The OIG calls particular attention to schemes in which providers take such actions with either no or limited patient interaction or review of medical records, as well as those involving volume-based fees, which the OIG...
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