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Yes Virginia, the government does investigate telemedicine

Telemedicine

Disclaimer: This blog article was written by an AdvancedMD partner. The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of AdvancedMD.

On August 10, 2021, the Department of Justice issued a press release announcing the indictment of Creaghan Harry, Florida resident and owner of multiple telemedicine companies, for telemedicine fraud.

The federal grand jury’s superseding indictment charged Harry with orchestrating health care fraud and accepting illegal kickbacks. Involving the submission of over $784 million in false claims, it’s one of the largest Medicare fraud schemes ever charged by the Justice Department. The indictment also charges the defendant with concealing scheme proceeds to avoid income tax payment.

According to the indictment, Harry and his co-conspirators solicited illegal kickbacks from durable medical equipment (DME) suppliers and marketers in exchange for orders of braces and medications. Harry’s telemedicine companies allegedly paid physicians to write medically unnecessary orders for these braces and medications. Then fraudulent claims were submitted to Medicare for repayment on these false orders. Of the $784 million in claims submitted, Medicare ended up paying over $247 million.

There is really nothing new in this indictment. Improper prescriptions were written, doctors were paid to write the improper prescriptions, and the suppliers provided kickbacks in the form of monetary payment for placing the orders. What is new is the use of telemedicine to manage the scheme and the amount fraudulently claimed. The government now understands how, given their extended reach, telemedicine operations can leverage patient access to commit fraud on a much greater scale than could be achieved by conventional medicine practices.

If you are currently engaged in telemedicine or considering adding telemedicine to your practice, it is vital that you:

  1. Document the medical necessity of all items you order, including medicine and DME.
  2. Do not allow a telemedicine provider to select vendors when ordering items.
  3. Do not accept anything of monetary value outside of direct product purchase from vendors, including those you refer patients to and those that supply medical products paid for by a healthcare payor.
  4. Understand the government may investigate telemedicine claims more carefully now, auditing more for telemedicine fraud, waste, and abuse.

Michael L. Brody, DPM

Disclaimer: Dr. Brody is the CEO of TLD Systems. TLD Systems assists practices in compliance with HIPAA, OSHA and the Federal Fraud, Waste and Abuse statutes. For more information, visit http://www.tldsystems.com , email [email protected], or call (631) 403 6687.



Michael Brody, DPM
Dr Brody has been actively involved in Computers and Medicine since the 1980’s. Dr Brody as a Residency Director at a VA hospital on Long Island and was present as the VA moved from paper records to computerized records. During this time, he was exposed to the stringent rules and regulations that government employees need to adhere to when protecting patient information. He co-founded TLD Systems with Warren Melnick to create a platform that doctors who wish to work in private practice have a cost-effective method of implementing HIPAA compliance in their practices in a manner that does not interfere with their ability to practice medicine. He has served on the Health Information Technology Standards Panel (HITSP), the Standards and Interoperability Framework (S&I), as a member of the Ambulatory Care Committee at the Certification Commission on Health Information Technology (CCHIT), and numerous other organizations. He is currently a member of the Physicians Committee at the Healthcare Information and Management Systems Society (HIMSS) and a co-Chair of the EHR workgroup at Health Level Seven International (HL7)

Topic: Telemedicine


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