TELEMEDICINE IN THE JUSTICE DEPARTMENT’S CROSS-HAIRS
Health Care Law Section
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As the government
spends more and
more money on
telemedicine,
increased
enforcement is likely.
T
he last few years have
seen an explosive
growth of telemedicine.
Some estimates peg the
global telemedicine technologies
market, including hardware,
software, and services, at nearly
$40 billion in 2018. Incredibly,
this market is projected to grow by
18 percent annually over the next
six years, reaching $103 billion in
2024. Given the increased use of
telemedicine, federal prosecutors
and regulators are beginning to
take note. Here, we chronicle some
recent trends by prosecutors and
offer practical advice.
Legal Developments
The first development in the
telemedicine enforcement space
came in April 2018, when the
Department of Health and Human
Services, Office of Inspector General
(HHS/OIG), issued a report entitled
“CMS Paid Practitioners for
Telehealth Services that did not
Meet Medicare Requirements.”
As its title suggests, the report took
issue with telemedicine providers
and noted that upwards of one-
third of all telemedicine claims
were improper.
On the heels of that report, the
Department of Justice announced
an indictment in Tennessee linked
to a “billion-dollar telemedicine
fraud conspiracy.” According to the
indictment, the defendants set up
an elaborate scheme in which a
telemedicine company “fraudulently
solicited insurance coverage
information and prescriptions from
consumers across the country.”
And finally, in December 2018,
the U.S. Attorney’s Office in Utah
announced a multi-million-dollar
False Claims Act settlement. The
United States alleged that the com -
pany violated Medicare’s prohibition
against telephone solicitation of
covered products to beneficiaries.
Best Practices
In light of this enhanced
enforcement scrutiny, providers
interested in telemedicine would be
well-served by erring on the side of
caution as the regulatory landscape
is still being developed. We outline
a few practical recommendations
that are best practices.
Make Sure the Patient is
Receiving Telemedicine
Services at a Qualified Site.
Telehealth services must be
furnished to a beneficiary at an
eligible originating site, which is
one of the following: the office of
a practitioner, a hospital, a critical
access hospital (CAH), a rural
health clinic, a federally qualified
health center, a hospital-based or
CAH-based renal dialysis center,
a skilled nursing facility, or a
community mental health center.
Continued on page 39
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