Telehealth Billing Schemes: Billing Medicare or Medicaid for telehealth visits that never took place, for services provided by practitioners who never interacted with the patient, or for services that do not meet Medicare’s coverage requirements for telemedicine. This includes billing for audio-only visits as video visits, billing for services provided by unlicensed or excluded personnel, and submitting claims for telehealth encounters that consisted of brief, scripted calls with no legitimate clinical assessment.
Kickback Arrangements: Using telemedicine platforms as a vehicle to generate illegal kickbacks. Common schemes involve telehealth companies that pay physicians a fee for each order they sign, regardless of whether the physician had a legitimate relationship with the patient or reviewed the patient’s records. These arrangements violate the Anti-Kickback Statute because the physician’s order is induced by the payment rather than a clinical determination. Claims submitted to Medicare as a result of such orders are false claims under the False Claims Act.
Remote Prescribing Fraud: Using telehealth encounters to generate prescriptions or orders for durable medical equipment, laboratory tests, or other items that are not medically necessary, without adequate examination of the patient. This includes telemedicine companies that use brief phone calls or online questionnaires to generate orders for orthotic braces, genetic tests, or other items that are then billed to Medicare, with kickbacks paid to the telemedicine company or physician for each order placed.
