This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity between August 21 and September 20, 2022, including a guilty plea from a telemedicine physician who wrote prescriptions for thousands of patients without personally evaluating medical necessity, in exchange for per-visit fees. A federal jury similarly convicted a physician for fraudulently billing TRICARE for diagnostic tests that were not provided or were medically unnecessary, and in some cases inducing TRICARE beneficiaries to provide testing specimen in exchange for gift cards. During this period, the Office of Inspector General (OIG) issued two advisory opinions that, addressed an arrangement between a health system and a federally qualified health center (FQHC) look-alike, and an arrangement between a Medigap plan and a preferred hospital organization (PHO).
We also review several other notable developments, including OIG’s intent to audit a sampling of hospitals’ compliance with the hospital price transparency rule, an OIG report recommending targeted reviews of telehealth services, and a federal court decision denying the US Department of Justice’s (DOJ’s) attempt to block a proposed UnitedHealth transaction on antitrust grounds.
