You saw patients over a telehealth platform, built or ran the platform, or connected doctors to the companies that needed orders, and now the government is calling it fraud. Telemedicine fraud is the connective tissue of modern healthcare enforcement.
You saw patients over a telehealth platform, built or ran the platform, or connected doctors to the companies that needed orders, and now the government is calling it fraud. Telemedicine fraud is the connective tissue of modern healthcare fraud enforcement. The same telehealth model sits underneath the biggest genetic testing, DME, and prescription schemes the Department of Justice has charged, and prosecutors have moved from indicting the labs and suppliers to indicting the doctors who signed and the platforms that arranged it. If you have received a target letter, a subpoena, or a visit from agents, you are already inside the investigation.
This page explains how telemedicine cases are built and defended, in plain terms, for the physician, platform operator, or marketer who is worried about exposure.
Telehealth is legal and, since the pandemic, everywhere. The prosecutions are not about practicing medicine online. They are about two things: whether a real physician-patient relationship existed, and whether money was paid to generate orders.
The pattern the government charges is consistent. A platform or marketing company routes Medicare beneficiaries to physicians. The physician signs orders for braces, genetic tests, pain creams, or prescription drugs, often after a brief call or no meaningful encounter at all, and is paid per consult or per order. A lab, DME supplier, or pharmacy then bills Medicare. Prosecutors describe the telehealth visit as a rubber stamp that manufactured the paperwork to justify the billing, and they describe the per-order payments as kickbacks.
The COVID-era expansion of telehealth created an enormous paper trail. That trail is now the evidence.
These cases begin with data and platform records. Analytics flag physicians who signed an unusually high volume of orders, or platforms whose doctors did. The government then pulls the consult logs, the payment records, the marketing contracts, and the downstream billing. The signing physician is easy to identify because the order carries a name. HHS-OIG and the FBI build the financial picture. When agents reach you, the question is intent: did you know the encounters were not real medicine and the payments were for orders.
Telemedicine cases are charged under 18 U.S.C. 1347, the Anti-Kickback Statute, 42 U.S.C. 1320a-7b(b), conspiracy under 18 U.S.C. 1349, and wire fraud under 18 U.S.C. 1343. When laboratories are in the chain, EKRA, 18 U.S.C. 220, applies too. The government must prove you acted knowingly and willfully. A physician who believed the platform delivered legitimate patients, reviewed records, and made real clinical judgments is not a criminal because a lab downstream committed fraud. The rubber-stamp label is an argument, not a fact, and it is the government's burden.
Section 1347 carries up to ten years per count, twenty if patient harm is alleged, and each kickback count adds up to ten years. The government adds forfeiture, sometimes money laundering, and civil liability under the False Claims Act, 31 U.S.C. 3729. For physicians, an indictment threatens the medical license, DEA registration, and the ability to bill federal programs. Because the signing doctor's name is on every order, physicians are often exposed to large aggregate loss figures even when their per-order payment was small.
Rebuild the encounter. The heart of the defense is showing the telehealth visits were real medicine: intake records, patient histories, clinical notes, and standard-of-care judgments. The government wants to try these in bulk. Each encounter is its own fact.
Use the pandemic waivers correctly. Federal telehealth rules were relaxed during the public health emergency, and what was permissible shifted over time. The rules in force on the date of the conduct matter, and the government does not always apply them accurately.
Attack the kickback characterization. Fair-market-value compensation for legitimate physician services is not a kickback. We test the pay structure against the Anti-Kickback Statute and its safe harbors, and separate payment for work from payment for orders.
Show what the client could see. Platform operators and physicians usually saw one slice of the operation. We build the record of what your client actually knew and controlled, which limits both liability and loss. The downstream biller, whether a genetic testing lab, a DME supplier, or a pharmacy, sat in a different position than the signing doctor.
Telemedicine investigations develop over many months, and there is almost always a pre-indictment window. That window is where a physician can be moved from target to witness, where a platform can present its compliance structure, and where counsel can argue a client out of the case before a grand jury ever sees it. After indictment, that leverage is gone. In this area, the providers who wait for charges before hiring counsel give up the phase where the case is most winnable.
The government's claim is usually not that no visit happened, but that the visit was not a real physician-patient relationship and existed only to generate billable orders. Whether your encounters were legitimate medicine is a factual defense, and it is the center of the case. Real, documented clinical work is the strongest answer to the rubber-stamp theory.
Not by itself. Physicians can be paid fair market value for legitimate services. It becomes a kickback problem when the government can show the payment was really for the volume of federally reimbursable orders you produced. The structure and the documentation of your compensation are what matter.
It can. Good-faith reliance on the platform's representations, on counsel, and on a compliance program is relevant to whether you acted willfully. It is not an automatic defense, but it is often a powerful part of the intent picture, and it should be documented early.
Sometimes, in part. The public health emergency loosened several telehealth restrictions, and the applicable rule depends on the date of the conduct. Prosecutors do not always get this right. The waivers are a real defense tool when applied to the correct timeframe.
Because the doctor's signature is what made the claim payable, and the name is on the order. The government has shifted toward charging the signing physicians and the platform builders, not just the downstream billers, on the theory that the orders were the engine of the fraud.
It depends on the loss the government attributes to your signatures and your role, but Section 1347 allows ten years per count and the guideline range is driven by the dollar figure. Because a signing physician's orders can total large sums, the aggregate exposure can be significant even for a modest per-order fee. Limiting attributable loss is central to the defense.
An indictment can trigger licensing board action and threaten your DEA registration and federal billing privileges, sometimes before the criminal case resolves. These fronts have to be defended together with the criminal case.
Not without counsel. Agents are gathering statements to prove you knew the encounters were shams. Decline to answer, do not consent to a search without a warrant, and do not produce records in response to a subpoena without a lawyer reviewing it first.
Preserve everything, say nothing to agents, and get counsel engaged before you respond to any subpoena or interview request. The pre-indictment window is the most valuable phase of the case. Contact AMC Defense Law for a confidential consultation.
You did your part and nothing more. On October 23 the Eleventh Circuit held a co-conspirator's conduct can still raise your sentence. See how to contest it.
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Does your significant difference note read the same for every patient? FDA's September 2026 warning letter calls that pretextual. Your exposure, and the fix.
Subpoena over a genetic testing or DME arrangement? Marchetti and Sorensen changed what the government must prove. See the records that win before indictment.
Federal healthcare fraud cases are built from claims data before anyone is interviewed. By the time HHS-OIG or FBI agents knock, the government usually has months or years of billing analysis, and often a cooperating insider. The defense has to start where the government started: the data, the medical records that support or undercut medical necessity, and the financial relationships behind the referrals.
You own or run a durable medical equipment company, you marketed for one, or you signed brace orders as a doctor, and now the government is treating that business as a fraud scheme. DME fraud has been one of the Department of Justice's top healthcare enforcement priorities for years.
You ran a lab, marketed for one, or signed test orders as a physician, and now federal agents are asking about cheek swabs, Medicare billing, and the people who sent you patients. Genetic testing fraud is one of the most aggressively prosecuted healthcare schemes in the country, and the Southern District of Florida is one of its main stages.
An Anti-Kickback investigation usually means the government believes money changed hands to influence where patients or healthcare business went. These cases are built quietly, often alongside a sealed whistleblower lawsuit you do not even know exists.