In September 2020, Frier Levitt described how Humana Pharmacy Solutions, Inc. and affiliated Humana entities (“Humana”) filed a lawsuit against a Florida-based telemedicine company, QuivvyTech Corp., and its affiliated physicians (“QuivvyTech Defendants”). In its lawsuit, Humana alleged that the defendants were involved in a fraudulent scheme to prescribe and bill for medically unnecessary prescriptions to Humana.
Of note, and as described in various case filings, Humana’s lawsuit against the QuivvyTech Defendants is distinct from the claims that Humana has brought against certain pharmacies, which are each subject to an arbitration agreement pursuant to Humana’s payor agreement with each pharmacy.
Humana’s action is significant in that the QuivvyTech Defendants are not parties to an agreement with Humana. Instead of more traditional claims involving breach of contract, Humana’s lawsuit against the QuivvyTech Defendants is largely rooted in violations of the Racketeer Influenced and Corrupt Organizations Act (“RICO”), an Act passed by Congress with the declared purpose of seeking to eradicate organized crime. Moreover, Humana alleged various violations of consumer protection laws, including Florida’s Deceptive and Unfair Trade Practices Act and the Federal Trade Commission’s Telemarketing Sales Rule.
Key Takeaway
As demonstrated by the case against the QuivvyTech Defendants, a variety of federal and state laws exist through which a third party, such as a payor, may attempt to target individuals and entities involved in a telehealth model with which the third party has taken issue, even if those individuals or entities are not contracted with the third party. While many telehealth technology companies or marketing agents believe their actions are insulated from payor scrutiny because, for example, only the prescriber or pharmacy are contracted with the insurer, Humana’s use of consumer protection laws, and its ability to defend its standing as a “consumer” against the QuivvyTech Defendants, are indicative of the creative measures payors may take to limit activities they find abusive.
How Frier Levitt Can Help
Frier Levitt has extensive experience advising healthcare and technology clients in the development of telehealth models and associated marketing initiatives that comport with applicable regulatory requirements. In addition to developing or restructuring telehealth models for compliance, Frier Levitt has experienced attorneys who are prepared to respond to and defend clients against payor audits, disputes, or terminations, as well as government investigations. Contact us today to discuss your concerns.
