[co-author: Maura Friedlander]

The July 20, 2022 Special Fraud Alert describes findings from what OIG describes as “dozens of investigations of fraud schemes involving companies that purported to provide telehealth, telemedicine, or telemarketing services” (collectively called “Telemedicine Companies”) that “exploited the growing acceptance and use of telehealth.” While the practices that OIG criticizes vary in their design and operation, one common component OIG cites is the use of kickbacks to recruit and reward practitioners—both physicians and non-physicians—into the purportedly fraudulent schemes. Specifically, in many of the arrangements it investigated, OIG found that companies paid practitioners in exchange for ordering or prescribing items or services (1) for “purported patients” with whom the practitioners had little or no interaction, and (2) without regard to medical necessity. OIG further observed that in many instances, the Telemedicine Companies would in turn sell the orders or prescriptions to others who then fraudulently billed for the unnecessary items or services.

OIG describes several “fraud concerns” it believes are implicated by these arrangements, including: (1) an inappropriate increase in costs to federal health care programs through the ordering of medically unnecessary items and services; (2) potential harm to beneficiaries through medically unnecessary care, harmful items, or improperly delayed care; and (3) corruption of providers’ independent...

Read Full Story: https://www.jdsupra.com/legalnews/oig-alert-and-doj-enforcement-action-1017340/