When health care providers tell me that "telemedicine" is now "legal," I respond that the same standard of care applies and that they need to be very careful regarding how the patients are seen, referred, examined and ensure that the medical record keeping and reports also meet the standard of care.
Health care providers who do telemedicine as a subcontractor also need to make sure they know who they are working for and how the visit is going to be billed. In addition, they need to see whether they are paying a third party for management fees or billing that could be classified as payment for referrals.
The number of health care fraud cases that arise where the patients have been treated or prescribed after "telemedicine" consultations or exams is on the rise. A recent case shows how Skype was used to allow a psychiatrist to see patients but it appears the reports and billing may not have met the standard of care and even delved to the abyss of false billing.
Dr. John Thomas Terrence of Marina del Rey pleaded guilty on July 16, 2018 to
health care fraud involving the alleged defrauding of California workers’
compensation insurers. This was an Indictment that had been filed in July 2015 and related to conduct from 2005 to 2012. Criminal cases often deal in ancient history or acts occurring years prior.
According
to court documents, Dr. Terrence, a clinical psychologist saw patients in
Bakersfield by “Skype.” Reports were generated for each patient that were virtually
word-for-word identical and then submitted identical bills to the insurance
companies.
Co-defendants and chiropractors Bhahar Gharib-Danesh of Woodland Hills and Na
Young Eoh of Bakersfield were chiropractors working at or with the same
company. They previously pleaded guilty to health care fraud charges in
this case. The three defendants admitted to assisting in submitting bills
to workers’ compensation insurers for medical-legal evaluations for which they
were not legally permitted to bill.
Pain
Free Diagnostics Inc. (dba Pain Free Management) pleaded guilty on July 9,
2018, to conspiracy to commit health care fraud and agreed to pay restitution
to the defrauded worker’s compensation insurers in the amount of $1.2 million.
Dr. Terrence, age 72, is scheduled to be sentenced by U.S. District Judge Lawrence J. O’Neill on
October 22, 2018. Chiropractor Gharib-Danesh is scheduled to be sentenced on October 1,
2018; and Chiropractor Eoh is scheduled to be sentenced on September 4, 2018.
Each
defendant faces a maximum statutory penalty of 10 years in prison and a
$250,000 fine. The actual sentences, however, will be determined at the
discretion of the court after consideration of any applicable statutory factors
and the Federal Sentencing Guidelines, which take into account a number of
variables.
Posted by Tracy Green, Esq.
