Can You Prevent Telehealth Fraud?
Telemedicine has continued to thrive in a post-pandemic world, but with the expansion of services comes the expansion of fraud.
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The Office of Inspector General (“OIG”) has warned healthcare entities to use ‘heightened scrutiny’ when entering telemedicine arrangements that have suspect characteristics of a fraud scheme.
The OIG has stated that a common characteristic of fraudulent schemes is the use of kickbacks to recruit and award healthcare practitioners.
The OIG further warns that enforcement is continuing. The OIG and the Department of Justice (DOJ) have investigated many fraud cases involving telemedicine companies.
In their investigations and cases, healthcare practitioners, telemedicine companies, and other participants have been held civilly, criminally, and administratively liable for their participation.
Some of the violations include:
- Violations of the federal anti-kickback statute,
- Submitting claims in violation of the False Claims Act, and/or
- Violations of other federal criminal laws.
Often, these cases involve a healthcare practitioner ordering or prescribing items or services for purported patients that were never examined or meaningfully assessed to determine medical necessity.
What should you watch out for?
Healthcare practitioners should be on the lookout for suspect characteristics, including, but not limited to:
- Patients identified or recruited by the telemedicine company,
- Insufficient contact or information from the purported patient to assess medical necessity,
- Compensation from the telemedicine company based on the volume of items or services ordered or prescribed,
- Telemedicine companies that only provide items and services to federal healthcare program beneficiaries,
- Telemedicine companies that only furnish one product or a single class of product that might restrict treatment options, and
- Telemedicine companies that don’t expect practitioners to follow up with patients or provide follow-up contact information.
Why does this matter for you?
Healthcare entities that engage with fraudulent telemedicine companies can face criminal, civil, or administrative liability, based on the situation.
It is essential to vet your vendors well. If you need help vetting vendors, contact Rickard & Associates today.
If you have questions or need help with your healthcare contract or your termination clause, contact Rickard & Associates today.
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