OIG Cautions Health-Care Practitioners about Fraud Schemes with Telehealth Companies

On July 20, 2022, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a Special Fraud Alert cautioning physicians and other health-care practitioners to use “heightened scrutiny” when entering into telemedicine arrangements that have “suspect characteristics” of a fraud scheme. The alert’s release follows significant enforcement actions by federal regulators as patients and practitioners have become more accustomed to delivery of care via telemedicine.

The OIG Special Alert specifies that fraudulent arrangements “vary in design and operation, and they have involved a wide range of different individuals and types of entities, including international and domestic telemarketing call centers, staffing companies, practitioners, marketers, brokers, and others.” The alert highlights that these arrangements often have one key element in common: the payment of kickbacks to physicians and other practitioners for ordering or prescribing medically unnecessary items and services to individuals with whom the practitioners have very little, if any, interaction. In many instances, the telemedicine companies solicit and recruit the purported “patients” and then sell the practitioners’ prescriptions or orders to another party, which then fraudulently bills the items and services to federal health-care programs and/or other payers.