Based on recent enforcement actions and increased scrutiny in telemedicine, the Office of Inspector General (OIG) recently published a Special Fraud Alert1 regarding fraud concerns in arrangements between healthcare professionals (HCPs) and telemedicine companies (including telehealth and telemarketing companies), providing a list of suspect characteristics that may increase criminal, civil, or administrative liability to parties in such arrangements, depending on the facts and circumstances. The OIG noted that a common element among fraud schemes in the telemedicine space is the use of kickbacks to aggressively recruit and incentivize HCPs to order or prescribe medically unnecessary items and services for purported patients solicited and recruited by telemedicine companies, often delaying needed care or not providing opportunities for HCPs to meaningfully determine the medical necessity of such items or services. Examples of high-risk payments included paying HCPs fees based on the volume of federally reimbursable items or services ordered or prescribed by the HCPs to incentive utilization of medically unnecessary items or services; and payment per review, consult, or assessment of medical charts when HCPs were not given an opportunity to review the patient's real medical records.
While the list provided by the OIG is not exhaustive, arrangements that involve one or more of the suspect characteristics identified by the OIG are associated with a heightened risk of fraud...
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