Department of Justice Cracking Down on Telemedicine Fraud

Barry M. Wax

The U.S. Department of Justice is going to great lengths to take down telemedicine fraud. This has become a serious issue that the government wants to put a swift end to as more patients opt for the convenience of medical care and advice from the comfort of their own homes.

Telemedicine provides an important and convenient service for those who are otherwise unable to seek out in-office care. Patients can seek out diagnosis and treatment by getting on the phone or through a video call with a medical professional without ever leaving their homes. There are inherent benefits to such a service, but we’ve seen numerous indictments targeting bad actors looking to take advantage of the service.

If you’re a practitioner it’s important to be aware of how the schemes are playing out. The Office of Inspector General issued an alert in July to warn of how purported telemedicine companies are defrauding the system. Officials want practitioners to tread carefully before entering into an agreement with a telemedicine company. Thorough research into the company, its practices, and how they’re systematizing the patient pipeline will provide needed insight into the legitimacy of the provider.

These schemes often center around durable medical equipment and genetic lab testing, but several other practices are also seeing this trend. Essentially, the telemedicine company will put forth serious effort to farm patients through marketing campaigns that push a patient to a call center. Once the call centers “qualify” the patients, i.e., obtain their Medicare or insurance information, they are routed to a telemedicine doctor who writes a prescription for orthotic braces or genetic lab testing which may not be medically necessary. Illegal kickbacks in the form of payments to the call centers for the prescriptions are at the heart of the fraudulent scheme and expose everyone involved to potential criminal prosecution for healthcare fraud.

The Inspector General alert in July coincided with one of the largest healthcare fraud busts in U.S. history – to the tune of $1.2 billion for dozens of defendants. The Department of Justice announcement outlines an example where these marketing efforts result in a prescription for cardiovascular genetic testing that is not even approved by Medicare as a means of diagnosing whether or not the patient has a cardiac condition. In one case alone, over $174 million in false claims were allegedly submitted to Medicare.

DOJ officials say this crackdown is part of a widespread federal effort to fight healthcare fraud and investigate those “who target Medicare beneficiaries and steal from taxpayers for personal gain.” It’s imperative to be aware of these efforts and take the necessary steps to avoid unknowing involvement with one of these schemes.

A deal that seems too good to be true involving call center marketing and telemedicine could put you in the crosshairs of an investigation. If you need help navigating the laws surrounding these practices or need advice defending yourself if you unwittingly get caught up in one of these schemes, contact Barry M. Wax Attorney at Law. We can give you the ability to make the right choices and regain control of your life.

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