State Law Failure to Establish a Bona-Fide Practitioner-Patient Relationship: The statute or regulation often states, a bona fide practitioner-patient relationship shall exist if the practitioner has:
(i) obtained or caused to be obtained a medical or drug history of the patient.
(ii) provided information to the patient about the benefits and risks of the drug being prescribed.
(iii) performed or caused to be performed an appropriate examination of the patient, either physically or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically; and
(iv) initiated additional interventions and follow-up care, if necessary, especially if a prescribed drug may have serious side effects.
State Law Telemedicine Requirements: These vary, but they generally state:
(i) Practitioner must comply with all existing laws and regulations.
(ii) Practitioner must take appropriate steps to establish a practitioner-patient relationship.
(iii) Where an existing practitioner-patient relationship is not present, a practitioner must take appropriate steps to establish a practitioner-patient relationship consistent with the guidelines identified in the state statute.
(iv) Often the practitioner must be licensed by, or under the control of, the regulatory board in the state the patient is located.
(v) Audio and physical connection with the patient is almost always required.
(vi) A legitimate medical purpose must be established for the care provided, including any prescription, DME, etc.
(vii) Often, a plan of care is required, even if simply to follow up with the primary care doctor
Federal False Claims Act (31 U.S.C. 3729-3733): This states it is a violation if the physician:
(A) Knowingly presents, or causes to be represented, a false or fraudulent claim for payment or approval.
(B) Knowingly makes, used, or causes to be made or used, a false record or statement material to a false or fraudulent claim.
(C) Conspires to commit a violation of subparagraph A, B, D, E, F, or G.
Federal Anti-Kickback Statute 42 USC §1320a-7b:
a. Making or causing to be made a false statement or representation
(1) whoever knowingly and willfully makes or causes to be made a false statement or representation of a material fact in any application for any benefit or payment under a federal health care program.
b. Illegal Remuneration
(1) whoever knowingly and willfully solicits or receives remuneration directly or indirectly, overtly or covertly, in cash or in kind —
(A) in return for referring and individual to a person for furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a federal health care program
Conspiracy to Defraud the Government (18 U.S.C. 371): It is illegal for two or more person to conspire to defraud the government. There are also state-specific statutes for conspiracy
Money Laundering (18 U.S.C. 1956): Engaging in a financial transaction with money that was obtained from criminal activity with the intent to try and