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Telemedicine: A review of the fraud and abuse landscape

Health Care Partner Douglas Grimm and Associate Hillary Stemple authored an article for the March 2019 edition of Compliance Today titled “Telemedicine: A review of the fraud and abuse landscape.”

The article addresses the rapid expansion of the telemedicine industry and the rules with which companies and practitioners planning to join the industry need to comply. Importantly, as Federal reimbursement for telemedicine services continues to increase, there will be a growing emphasis on enforcement of both federal and state fraud and abuse laws with respect to providers providing services via telemedicine. 

“To ensure compliance with these laws, parties entering into arrangements related to the provision of telemedicine services should closely consider the federal and state laws that may be implicated and how to structure those arrangements to comply with any applicable safe harbors or exceptions. Although such steps may seem onerous, failing at the outset to ensure an arrangement is structured in a compliant manner could ultimately result in the parties to the arrangement violating the law and being subject to civil, and in some instances criminal, penalties.”

Key Takeaways

  • 2018 had several important advancements for the provision of telemedicine services, but also a new emphasis on future risk of increased enforcement.
  • As federal dollars spent on telemedicine increase, so will government enforcement.
  • Federal laws governing telemedicine arrangements and services include the Anti-Kickback Statute, the Stark Law, and the False Claims Act.
  • Many states maintain laws governing telemedicine arrangements that apply to arrangements involving the submission of claims to commercial payers and private pay patients. 
  • Parties entering into telemedicine arrangements involving the employment of or contracting with physicians must comply with state corporate practice of medicine laws.

To read the Compliance Today article, click here.

Copyright 2019 Compliance Today Magazine, a publication of the Health Care Compliance Association (HCCA).


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