Fraud and Abuse in Digital Health

As health care operations continue trending toward digital, providers, payors, and vendors must adapt their practices to minimize fraud and abuse risks. The increase in digital health delivery models creates new types of risks under legal theories that are regularly scrutinized by the Department of Justice (DOJ) and health care regulators. For example, as providers move toward telehealth, they must be careful to protect against allegations involving medical necessity and arrangements that could implicate the Stark Law and Anti-Kickback Statute. The government has also prioritized scrutiny over certain types of health care vendors, like those that provide electronic medical record solutions and other telehealth services, to ensure that the tools and services they provide do not lead to fraud and abuse. Should an investigation occur, clients need a team that can interact with various federal and state enforcement agencies that often work health care fraud investigations together, such as the FBI, U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), state Medicaid fraud control units, and Food and Drug Administration.

As the rules continue to evolve during this transformation in health care, providers, payors, and telehealth IT companies will need trusted counsel with the experience and connections to assist with potential fraud and abuse and Stark Law and Anti-Kickback Statue issues before the DOJ.

Clients may face issues such as:

  • Increasing scrutiny from the DOJ, HHS-OIG, and state attorneys general.
  • An uptick in investigations arising under laws governing referrals and physician relationships (e.g., Stark Law, Anti-Kickback Statute).
  • Scrutiny over the medical necessity of digital health services.
  • Updating their compliance programs to adjust to developments in telehealth.

Our team includes former U.S. assistant attorneys and DOJ prosecutors and can assist with preparation and response to:

  • Criminal and civil government investigations.
  • Internal and independent investigations.
  • Governmental litigation and administrative proceedings.
  • False Claims Act and related litigation.
  • Health care payment disputes.
  • Antitrust and trade regulation actions.

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