OIG Issues Fraud Alert for Practitioners Working With Telehealth Companies

On July 20, the Office of Inspector General (OIG) released a special fraud alert to warn and encourage physicians as well as non-physician practitioners to exercise heightened caution when entering into arrangements with “purported telemedicine companies.” Dozens of investigations conducted by OIG revealed various fraud schemes utilized by such telemedicine companies. These inappropriate schemes were targeted at increasing the acceptance and use of telemedicine by paying kickbacks to medical professionals to generate orders and prescriptions for medically unnecessary durable medical equipment, genetic testing, wound care items, or prescription medications, which can result in submissions of fraudulent claims to Medicare, Medicaid and other federal health care programs. According to the U.S. Department of Justice (DOJ), Medicare fraud costs U.S. taxpayers billions of dollars every year.

In 2016 the global telemedicine market was valued at approximately $25 billion. It is predicted that by 2025 that number will reach $113 billion. Although the use of telemedicine services in the United States was on a steady climb even before the COVID-19 pandemic, it was underused and understudied. The all-around acceptance of telehealth was substantially low, considering integration and logistics issues. Prior to the spread of the coronavirus disease the services covered by federal health care programs through telemedicine were limited. In March 2020 the Centers of Medicare and Medicaid (CMS) decided to relax telemedicine rules and expand telehealth in response to the pandemic after a Public Health Emergency (PHE) was declared. Consequently, Medicare now covers many telemedicine visits, virtual check-ins, telephone visits and e-visits. Additionally, reimbursement for telehealth services, including audio only, has been the same as if the service was furnished in person. Other relaxed conditions were introduced such as no preexisting relationship requirement between the patient and the practitioner, as well as ability to conduct the virtual contact from home using expanded approved platforms like Zoom, FaceTime and Skype.