To facilitate the provision of care during the pandemic, the federal government and many state governments enacted changes that encouraged physicians and other nonphysician practitioners (collectively, Practitioners) to use telehealth services. While this new flexibility increased access to care, it also increased opportunities for fraud. On July 20, 2022, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a Special Fraud Alert cautioning Practitioners about potential fraudulent telemedicine contracts (Fraud Alert).

The Fraud Alert is derived from the lessons learned during the OIG’s coordinated enforcement action with the Department of Justice (DOJ) and other agencies that resulted in criminal charges against 36 defendants involving more than $1.2 billion in fraudulent telemarketing services identified as telehealth. The Fraud Alert highlights these common themes in telehealth arrangements that raised red flags to the OIG and DOJ investigators:

Notably, telehealth represents a great expansion of access to, and affordability of, healthcare services. Such virtual options save patients time and money; reduce patient transfers, ER and urgent center visits; and offer savings to payers. However, Practitioners must be mindful of the potential for abuse. The Fraud Alert reminds Practitioners that engaging in these problematic contracts could subject them to criminal, civil, or administrative liability under various federal and state fraud and abuse laws. Practitioners should speak with healthcare counsel familiar with these regulatory issues when considering or negotiating telehealth contracts.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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