Telemedicine Comes of Age: OIG is Prosecuting Telehealth Fraud

Tucker Arensberg, P.C.
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Tucker Arensberg, P.C.

You can now tell that telemedicine is a mature industry, because it has achieved enough critical mass that the fraud has started and the OIG is beginning to prosecute.  There is a lag time between when the cash flow and profit achieves sufficient critical mass to attract the criminals, the OIG identifies the problems, and the prosecution actually begins.

I am attaching a link to an OIG news release dated February 5, 2020 indicating the OIG is now prosecuting owners of a telemedicine company allegedly involved in arranging kickbacks for referrals.

https://www.justice.gov/opa/pr/two-owners-telemedicine-companies-charged-roles-56-million-conspiracy-defraud-medicare-and

Concurrently, the Office of the National Coordinator for Health Information Technology (ONC), which is a department of HHS, has proposed a rule to implement certain provisions of the 21st century Cures Act (Cures Act) designed to advance interoperability, support the access, exchange, and use of electronic health information, and make patients electronic health information (EHI) more electronically accessible through the adoption of standards and certifications for mobile digital applications (apps) on March 4, 2019, which proposed regulations are being studied by the White House.  The major app makers, i.e. Google, Apple, Microsoft, etc., the very industry giants seeking the access deals mentioned herein, believe interoperable health information apps should be as easily loaded as any other mobile app, but many regulators are concerned about the privacy and security of this data.  Attached is a link to the proposed rules.

https://www.healthit.gov/topic/laws-regulation-and-policy/notice-proposed-rulemaking-improve-interoperability-health

One of the critical issues is interoperability, and whether one app developer can program restrictions into that app that would prohibit the sharing of that information through other systems.  The restriction is fairly common with other commercial apps which do not contain PHI and do not interfere with a patient’s management of their own healthcare, or the management by or sharing with other systems.  However, that commercial application is viewed as incompatible with the idea of improving health care delivery through the use of mobile apps.

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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