OIG Warns Providers to Steer Clear of Telehealth Scams

For the first time in nearly two years, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services has issued a Special Fraud Alert. The subject: telehealth scams under which telehealth companies pay kickbacks “to aggressively recruit and reward” providers to order medically unnecessary items and services for what the OIG calls “purported patients” solicited by the company. The OIG lists six red flags of suspect arrangements:

1. The purported patients for whom the provider orders lab tests (or other items or services) were identified or recruited by the telehealth company, sales agent, recruiter, call center, health fair, and/or through internet, television, or social media advertising for free or low out-of-pocket cost items or services;
2. The provider doesn’t have sufficient contact with or information from the purported patient to make a meaningful assessment of whether the ordered tests (or other items or services) are medically necessary;
3. The telehealth company compensates the provider based on the volume of lab tests (or other items or services), which the company may describe to the provider as compensation based on the number of purported medical records the provider reviewed;
4. The telehealth company only furnishes items and services to federal health care program beneficiaries and doesn’t accept insurance from any other payor;
5. The telehealth company says it only furnishes items and services to individuals who aren’t federal healthcare program beneficiaries but may in fact bill federal healthcare programs; and/or
6. The telehealth company only furnishes one product or class of products, e.g., genetic testing, durable medical equipment, diabetic supplies, or various prescription creams, potentially restricting the provider’s treating options to predetermined courses of treatment.