Telemedicine networks may lead to fraud

OIG weighs value of community benefit’

The new frontier of telemedicine could include some fraud possibilities that may not be apparent immediately to risk managers. That’s the warning in the latest advisory from the Department of Health and Human Services Office of the Inspector General in Washington, DC.

The OIG reported that the financial arrangements in a rural telemedicine project would be outside the law if they were intended to induce patient referrals. The warning came in response to a request for clarification by an unnamed health care provider who wanted to know whether the use of federal grant funds and the continued operation of the telemedicine network after the expiration of the grant period would lead to sanctions for violating the antikickback rule.

The OIG said it would not impose sanctions on the arrangement because it provides a community benefit by developing a telemedi cine capability. The providers involved in the network were not identified, but the OIG described them as a health system and 10 out lying rural facilities, with the telemedicine system funded in part through two federal Tele - medicine Grant Program funds.

Telemedicine is an evolving field, and the reimbursement for it is also in evolution, the OIG reported. Medicare historically has reimbursed only those telemedicine applications if the same medical services would not require in-person, hands-on contact between patient and physician if delivered by conventional methods. But the arrangement considered by the OIG represents an opportunity for community benefit, so the OIG said it would not impose sanctions on the health system.