On July 20, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) issued a Special Fraud Alert to caution healthcare practitioners who may wish to enter into arrangements with telehealth companies. The Alert describes several types of fraud schemes that have resulted in federal investigations and civil and/or criminal charges, particularly since the start of the COVID-19 pandemic.
Telehealth fraud has been a frequent target for the OIG and the U.S. Department of Justice (DOJ) over the past several years, as previously discussed here. Typical schemes usually involve some combination of fraudulent genetic and cancer testing, medically unnecessary services or durable medical equipment (or services or DME billed for without actually having been provided), false billings to federal healthcare programs, and kickbacks to physicians and nurse practitioners involved in the schemes.
The Alert describes a number of potential indicators of fraud, including the telehealth company reimbursing a practitioner according to the number of services ordered, or providing services only to federal program beneficiaries. In summary, the OIG encourages practitioners to “use heightened scrutiny, exercise caution, and consider the above list of suspect criteria” before entering into arrangements with purported telehealth companies.
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