A New York anesthesiologist was indicted on July 9 for her participation in an alleged telemedicine conspiracy to submit fraudulent claims to Medicare, Medicare Part D, and private insurance plans. The physician was charged with one count of conspiracy to commit healthcare fraud.
According to the indictment, the physician, along with other providers, participated in a fraudulent scheme to order and prescribe Durable Medical Equipment (DME) and prescription drugs through telemedicine services from 2015 through 2018. The prescription drugs and DME orders were not medically necessary, resulted from kickbacks paid by a third party, and were issued to beneficiaries who had not been examined or evaluated by the provider. Furthermore, the prescriptions and orders did not result from encounters that satisfied the requirements for a valid patient-provider relationship pursuant to state law. The physician, and others involved in the scheme, allegedly submitted, or caused to be submitted, more than $7 million in claims for federally funded DME on behalf of more than 3,000 beneficiaries, of which Medicare paid more than $3 million.
This indictment, which follows the $1.2 billion telehealth DME fraud indictment in April, reinforces the current regulatory enforcement trend in telehealth. Telemedicine arrangements are highly scrutinized not only to evaluate kickbacks, but also for purposes of providers’ bona fide relationships with patients. Additionally, this indictment highlights the broad applicability of the federal healthcare fraud statute. Frier Levitt has analyzed and restructured numerous telehealth models to ensure the compliance and sustainability of these new business ventures. Contact us today for guidance and review of your current or proposed telemedicine arrangement.