Telemedicine Special Fraud Alert

The US Office of Inspector General (OIG) released another in a series of Special Fraud Alerts on July 20, 2022, this one directed to potentially fraudulent telehealth, telemedicine, and telemarketing service fraud schemes, collectively referred to as “Telemedicine Companies”.  The alert is based upon OIG’s perception that these Telemedicine Companies are engaged in schemes to pay kickbacks to practitioners to generate fraudulent orders for medical services, specifically:

  • Durable medical equipment
  • Genetic testing
  • Wound care items
  • Prescription medications

The Alert states that “telemedicine companies have used kickbacks to aggressively recruit and reward practitioners to prescribe items or services for”:

  1. Purported patients with which the practitioners have limited, if any interaction
  2. Prescribed items or services without regard to medical necessity”

The Alert goes on to identify common characteristics of fraudulent telemedicine company schemes, i.e.

  • The purported patients are identified and/or recruited by the Telemedicine Companies through a variety of means and then presented to the practitioners
  • Lack of sufficient contact or information to meaningfully assess medical necessity
  • Payment based upon the volume of items or services ordered or prescribed
  • The patient groups are limited to one category of third party payor, either only through a healthcare program or excluding federal healthcare programs
  • The telemedicine company furnishes only “one product or service”

The Alert also footnotes a list of prior alerts, prior investigations, and prior prosecutions.

Medicare Proposes 2023 Physician Pay Cuts

On July 7, 2022, CMS released its proposed Medicare Physician Fee Schedule for 2023, which proposes physician fee schedule reductions via the Medicare Conversion Factor.

  • The general Medicare conversion factor will be reduced by 4.4% from $34,61 to $33.08
  • The anesthesia conversion factor will be reduced 3.9% from $21.56 to $20.72

The link is attached here.

Mike Cassidy Published in the Allegheny County Medical Society’s Signature Publication

Mike Cassidy recently wrote an article entitled, “Private Equity Deals Offer Both Potential Significant Return and Significant Challenges” in the Legal Summary section of the July 2022 Allegheny County Medical Society (ACMS) Bulletin. The ACMS Bulletin is the Allegheny County Medical Society’s signature publication which reaches over 2,000 physicians in Southwestern Pennsylvania each month. Click here to read the article which offers useful information for physicians to be cautious about when considering private equity acquisition.

For more information on this, contact Mike Cassidy at mcassidy@tuckerlaw.com, (412) 594-5515

Tucker Attorneys Jeremy Farrell and Rebecca Moran Published in the Allegheny County Medical Society’s Signature Publication

Jeremy Farrell and Rebecca Moran recently wrote an article entitled, “Pregnancy-Related Protections for New Physicians” in the Legal Summary section of the June 2022 Allegheny County Medical Society (ACMS) Bulletin. The ACMS Bulletin is the Allegheny County Medical Society’s signature publication which reaches over 2,000 physicians in Southwestern Pennsylvania each month. Click here to read the article regarding Pregnancy-Related Protections for New Physicians.

Jeremy V. Farrell jfarrell@tuckerlaw.com (412) 594-3938
Rebecca A. Moran rmoran@tuckerlaw.com (412) 594-3941

2022 Budget Bill Includes Mandatory Healthcare Cyber Incident Reporting

The Cyber Incident Reporting for Critical Infrastructure Act (CIRCIA), was passed as part of the consolidated Budget Act for 2022, which also included the telehealth provisions I posted about last week.

The definition of “covered entity” in the Act is far greater than covered entity as defined by HIPAA.  Covered entity as per CIRCIA includes all of the entities identified by presidential policy directives as “designated critical infrastructure sector” entities.

However, the recent Medicare Compliance Reporter indicates that this will require hospitals to report cyber breaches in 72 hours and ransom payments within 24 hours to DHS.

The legislation gives the Cybersecurity and Infrastructure Security Agency (CISA) at DHS 24 months to propose implementing regulations, which then must be finalized 18 months thereafter, so we are looking at a window of approximately 3 and a half years at this point.

HHS Requesting Physician COVID Relief Payback of $100 Million

HHS sent notices to noncompliant physicians and facilities on March 10, 2022 giving them 30 days to return funds paid to healthcare providers who have not complied with the agency’s reporting requirements.  Attach is the PDF from HRSA (Health Resources and Services Administration), which is the agency responsible for dispensing and collecting the grant money.

 

 

Congress Extends Telehealth Coverage

The President and Congress extended Medicare telehealth coverage in the Consolidated Appropriations Act, which also included additional Ukrainian relief.

On Tuesday, March 15, 2022, President Biden signed the Consolidated Appropriations Act, 2022 (“2022 CAA”).  This new law includes several provisions that extend the Medicare telehealth waivers and flexibilities, implemented as a result of COVID-19 to facilitate access to care, for an additional 151 days after the end of the Public Health Emergency (“PHE”).

The 2022 CAA extension includes the basic PHE telehealth measures originally authorized in the Medicare pandemic response.

  • Geographic Restrictions and Originating Sites: Medicare beneficiaries can continue to receive telehealth services from anywhere in the country, including their home.  Medicare is permitting telehealth services to be provided to patients at any site within the United States, not just qualifying zip codes or locations (e.g. physician offices/facilities).
  • Eligible Practitioners: In addition to “physicians” as defined by Medicare, occupational therapists, physical therapists, speech-language pathologists, and qualified audiologists may continue to furnish and be paid for telehealth services as eligible distant site practitioners.
  • Mental Health: In-person requirements for certain mental health services will continue to be waived through the 151-day extension period.
  • Audio-Only Telehealth Services: Medicare will continue to provide coverage and payment for most telehealth services furnished using audio-only technology.  This includes professional consultations, office visits, and office psychiatry services (identified as of July 1, 20222 by HCPCS Codes 99241-99275, 99201-99215, 90804-90809 and 90862) and any other services added to the telehealth list by the CMS Secretary for which CMS has not expressly required the use of real-time, interactive audio-visual equipment during the PHE.

Highmark Fraud Waste and Abuse Results

Highmark Health issued a Press Release on February 7, 2022 announcing that it’s Financial Investigations and Provider Review (FIPR) department generated more than $245 million in savings related to fraud waste and abuse in 2021, the majority of which was in Pennsylvania–$184 million.

Click here to see to what the Highmark FIPR Department has identified as the “Red Flags of Fraud”.

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