On July 20, 2022, the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) issued a Special Fraud Alert for telemedicine, telehealth, and telemarketing services. During the pandemic, the OIG has responded to the expansion of telehealth services by aggressively pursuing fraud investigations against providers. Using these as examples, the OIG Alert identifies suspect arrangements that they will target as creating a risk of fraud and abuse, including the following:
- The purported patients for whom the practitioner orders or prescribes items or services are identified or recruited by the telemedicine company through various sources that advertise free or low out-of-pocket cost items or services.
- The practitioner does not have sufficient contact with or information from the purported patient to meaningfully assess the medical necessity of the items or services ordered or prescribed.
- The telemedicine company compensates the practitioner based on the volume of items or services ordered or prescribed, which may be characterized to the practitioner as compensation based on the number of purported medical records reviewed.
- The telemedicine company only furnishes items and services to Federal health care program beneficiaries and does not accept insurance from any other payor.
- The telemedicine company claims to only furnish items and services to individuals who are not Federal health care program beneficiaries but may in fact bill Federal health care programs.
- The telemedicine company only furnishes one product or a single class of products (e.g., durable medical equipment, genetic testing, diabetic supplies, or various prescription creams), potentially restricting a practitioner’s treating options to a predetermined course of treatment.
- The telemedicine company does not expect practitioners to follow up with purported patients nor does it provide practitioners with the information required to follow up with purported patients.
This list is not exclusive and non-identified arrangements with similar characteristics also may be targeted. Therefore, the OIG Alert encourages careful evaluation of any telemedicine arrangement with experienced professionals to avoid risks or mitigate potential violations.