OIG Special Fraud Alert: Arrangements with Telemedicine Companies

8/14/2022
OIG Special Fraud Alert: Arrangements with Telemedicine Companies

The Office of Inspector General has discovered a massive fraud scheme involving healthcare practitioners and telemedicine companies. According to a recent report, virtual health providers have been encouraging practitioners to issue orders or prescriptions for medically unnecessary items, medications, or equipment to specifically recruited patients with whom practitioners have had limited or no contact at all in exchange for a kickback. This has resulted in submissions of fraudulent claims to Medicare, Medicaid, and other Federal health care programs.

Below are the most typical characteristics of such fraudulent arrangements:

⛔️ Patients are recruited by a telemedicine company, sales agents, recruiters, or call centers offering to get a free or low out-of-pocket cost item or service

⛔️ A practitioner does not have enough information about a patient's clinical condition, nor are they able to request it

⛔️ A telemedicine compensates the Practitioner based on the volume of items or services ordered or prescribed

⛔️ Most of the patients are Medicare/Medicaid beneficiaries

⛔️ A company only furnishes one product or a single class of products

⛔️ A company discourages practitioners from doing follow-ups with patients or does not allow them at all

Participation in such or similar fraudulent schemes is illegal and may result in civil, administrative, or criminal liability.

If you cooperate with telemedicine providers and notice any of the above-mentioned signs, you should put this cooperation to an end.

If you are not sure whether your partners are trustworthy and if your billing patterns are transparent - contact us. Our billing and auditing experts may help you ensure that your practice is compliant with the local and federal regulations.
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