Telehealth Secrets 2019: Consumer initiated health care business models - Charles Dunham, JD, Greenberg Traurig, LLP
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The 2019 VSee Telehealth Secrets annual conference highlighted issues in healthcare regulations, urging for reforms to empower patients and reduce administrative burdens. The discussion covered Medicare telehealth expansions, fraud prevention strategies, and notable investigations linked to significant Medicare fraud schemes. Key regulatory changes and telehealth services were outlined, including recommendations for access and appropriate clinical use.
Telehealth Secrets 2019: Consumer initiated health care business models - Charles Dunham, JD, Greenberg Traurig, LLP
- 1. VSee Telehealth Secrets Annual Conference 2019 Legal Panel Discussion OCTOBER 02, 2019 www.gtlaw.com Charles C. Dunham | [email protected] | +1 713.374.3555
- 3. © 2019 Greenberg Traurig, LLP • “Over several decades, government has concocted a complex system of rules – a time-sucking morass that has contributed to obscene administrative costs and stifled innovation and competition.” • “Our administration is upending the status quo to empower patients to be informed consumers of healthcare, seeking out high value providers…those that deliver the highest quality of care at the lowest price.” CMS Administrator Seema Verma at AHA (09/10/2019) 3 “Patients Over Paperwork”
- 4. © 2019 Greenberg Traurig, LLP Medicare Telehealth Waivers and Carveouts Congressional Program Expansion CHRONIC Care Act Bipartisan Budget Act of 2018: End Stage Renal Disease and Acute Stroke Opioid Crisis Response Act (Substance Abuse – At Home) CMS Telehealth Waivers and Demonstration Projects Chronic Care management Tele-Stroke and Tele-Behavior programs Substance Abuse Telecommunication Technology-Based Services (not “Telehealth Services”) Virtual Check-In (E/M Services) codes Remote Patient Monitoring (RPM) codes Value-Based Care Medicare Shared Savings Program (Next Generation ACOs) Medicare Advantage Plans
- 5. © 2019 Greenberg Traurig, LLP Medicare Advantage (MA) Plans Basic Benefits Package (subject to section 1834(m) limitations) Medicare Expansion of Basic Benefits – Additional Telehealth Services MA Supplemental Benefits
- 6. © 2019 Greenberg Traurig, LLP MA Plan Benefits Additional Telehealth Services (1) services for which benefits are available under Medicare Part B, but are not payable under section 1834(m) of the Act, (2) and services that have been identified for the applicable year as clinically appropriate to be furnished through telehealth E.g. primary care visits, routine and/or specialty consultations, dermatological examinations
- 7. © 2019 Greenberg Traurig, LLP MA Plan Benefits Coverage Requirements Must be delivered by network providers Beneficiary’s right of choice to receive in-person visit or through electronic exchange Determination of “clinically appropriate” in advance Notice to beneficiaries in advance
- 9. © 2019 Greenberg Traurig, LLP • Advisory Opinions (99-14, 04-07 and 11-12) • Advisory Opinion No. 19-02 (2019) OIG approved a pharmaceutical manufacturer’s proposal to loan a limited- functionality smartphone to financially needy patients who do not have the technology necessary to receive adherence data from a sensor embedded in their prescribed antipsychotic medication • Advisory Opinion No. 18-03 (2018) OIG allowed a private health care center to equip a county clinic with IT- related equipment and services to facilitate Telemedicine encounters for HIV prevention that directly results in a service performed by donor payable by FHCP 9 OIG Advisory Opinions Telehealth Arrangements
- 10. © 2019 Greenberg Traurig, LLP 10 OIG Advisory Opinions Telehealth Arrangements Referral between originating and distant site providers Provision of free telehealth technology and equipment; but donor retains ownership Increased access to treatment with no increased cost to FHCPs Prioritize “health benefit” to the community Some common themes . . .
- 11. © 2019 Greenberg Traurig, LLP • “OPERATION BRACE YOURSELF” – DOJ Investigation • “One of the Largest Medicare Fraud Schemes in History” • $1.2 Billion Fraud Scheme -- DME/Pharma • International Shell Companies • DOJ Prosecutions: • Owner Of Telemarketing Company Plead Guilty To Conspiracy Charges to Defraud and Launder Money -- $200 Million Restitution • “Four Men and Seven Companies Indicted” (EDTN) • “Tampa Resident Sentenced to 20 Years” (SDFL) Telemedicine doctors providing the keys to unlock the doors 11 Headline News
- 12. © 2019 Greenberg Traurig, LLP • OIG Fraud Alerts: • Genetic Testing Scam -- Solicitation of Medicare Beneficiaries Telemarketing Calls, Public Events, Health Fairs, Nursing Homes and Door-to-Door Canvassing • “Operation Double Helix” – DOJ Investigation • “One of the Largest Medicare Fraud Schemes in History” • $2.1 Billion Fraud Scheme – Genetic Testing • International Shell Companies • Closely Held Laboratories Across the Country 12 Fraud and Abuse