Telehealth Fraud & Compliance: Preventing ‘Pill Mills’ While Ensuring Access to Care – MedCity News

Telehealth
unlocked
new
doors
and
allowed
patients
to
access
healthcare
with
simple
clicks
but
has
undergone
rapid
changes
recently.
As
with
the
advent
of
new
technologies,
new
problems
arise
and
virtual
“pill
mills”
stand
to
be
one
of
the
greatest
complications
as
they
abuse
the
loopholes
created
from
telehealth
platforms
to
distribute
controlled
substances
free
from
comprehensive
medical
attention.

Not
only
do
these
pill
mills
endanger
patient’s
lives,
but
telemedicine’s
credibility
plummets
as
well.
Stricter
rules
may
pose
as
a
helpful
balm,
but
these
‘solutions’
harm
genuine
digital
healthcare
users,
such
as
those
managing
chronic
illness
or
mental
health
services
in
sparsely
populated
areas.
The
approaches
rendered
are:
how
do
we
prevent
illicit
activities
without
bearing
down
access
to
fundamental
services?

The
rise
of
‘pill
mills’
in
telehealth 

During
the
telehealth
era,
the
operational
model
changed,
along
with
the
definition
of
a
“pill
mill”.
Now
clinics
are
referred
to
as
“pill
mills”
whose
only
requirement
is
to
evaluate
patients,
regardless
if
the
evaluation
is
proper,
and
write
a
prescription,
most
commonly
for
opioids
and
stimulants.
Some
online
platforms
advertise
and
make
their
registration
so
easy
that
they
become
the
face
for
questionable
prescription
practices. 

Done
Global,
a
mental
health
telehealth
platform
stumbled
into
controversy
in
2023
which
resulted
in
an
investigation.
They
were
accused
of
providing
widespread
prescriptions
of
Adderall
and
other
ADHD
medications
due
to
their
fast-paced
consultations
which
didn’t
include
proper
verification
diagnosis
and
follow
up
checks.
The
Department
of
Justice,
as
well
as
the
Drug
Enforcement
Administration,
initiated
inquiries
which
uncovered
the
ease
with
which
digital
systems
could
be
abused. 

These
types
of
misuse
tarnish
reputations,
but
their
impact
goes
beyond
that.
Other
patients
reported
experiencing
clinical
withdrawal
symptoms
as
they
were
forced
to
rapidly
find
alternative
care
solutions
during
the
investigating
shutdown.
Some
participants
underwent
overtreatment
with
no
means
of
recovery.

GLP-1
drugs:
A
new
frontier
for
fraud 

Telehealth
fraud
goes
beyond
ADHD
medication.
With
the
rising
demand
for
Ozempic
and
Mounjaro,
a
new
variation
of
fraudulent
activity
has
emerged
in
the
form
of
counterfeit
and
black-market
versions
of
prescription
medications. 

Falsified
semaglutide
products
have
been
reported
circulating
in
various
countries
in
July
2023,
as
stated
by
the

World
Health
Organization.
These
counterfeits
are
far
more
dangerous
as
they
frequently
lack
the
active
ingredient,
or
worse,
contain
harmful
substances. 

Why
is
this
the
case?
Drug
scarcity
along
with
exorbitant
pricing
and
patient
desperation
clearly
explain
it.
In
cities
such
as
New
York,
users
have
been
spotted
selling
GLP-1
medications
for
self
administration
on
Facebook
Marketplace.
In
the
media,
‘black
market
Mounjaro’
sales
have
also
been
reported
within
the
UK,
where
patients
are
purchasing
the
Mounarjo
injections
from
unscrupulous
sites. 

This
is
the
realm
of
the
shadow
economy,
where
law-abiding
access
is
restricted,
and
consumers
are
unable
to
differentiate
between
reliable
services
and
deceptive
ones.
For
consumers,
this
poses
serious

health
complications
–
from
adverse
allergic
responses
to
critical
conditions
being
missed
altogether. 

Understanding
the
regulatory
landscape

In
the
face
of
rampant
fraudulent
activities,
policy
enforcers
are
taking
decisive
action
and
increasing
penalties.
In
the
case
of
The

Ryan
Haight
Online
Pharmacy
Protection
Act,
first
instituted
in
2008,
at
least
one
in-person
assessment
for
controlled
substances
prescribing
must
be
done
prior
to
online
consultation.
However,
during
the
Covid-19
pandemic,
some
of
these
restrictions
were
temporarily
eased,
making
way
for
more
telehealth
services. 

With
temporary
waivers
about
to
be
canceled,
the
DEA
and
HHS
have
started
to
reconsider
what
a

flexible
but
secure
option
for
telemedicine
would
entail.
Suggestions
include
requiring
real-time
video
consultations,
more
restrictive
documentation
requirements,
and
explicit
criteria
defining
high
risk
prescribing. 

Some
states
have
already
passed
their
own
telehealth
fraud
laws,
targeting
companies
that
don’t
properly
vet
providers
or
that
rely
on
algorithm-based
prescribing
without
human
review.
Meanwhile,
recent
enforcement
actions
by
the
DOJ,
including
the
high-profile
Done
Global
probe,
suggest
that
regulatory
scrutiny
is
only
intensifying. 

But
the
pendulum
swings
both
ways.
Tough
enforcement
risks
penalizing
compliant
providers
and
cutting
off
access
for
at
risk
populations
–
especially
for
those
in
rural
or
mobility-limited
communities.
The
goal
has
to
be
an
equitable
approach,
separating
fraud
from
frictionless
care. 

Balancing
compliance
and
access

So
how
does
the
industry
protect
patients
without
slamming
digital
doors? 

The
answer
starts
with
rigorous
provider
validation.
These
platforms
must
perform
more
than
rudimentary
credential
verification
and
employ
in-depth
vetting
–
verifying
licenses,
board
certifications,
malpractice
records,
etc.
Providers
who
have
been
verified
are
the
first
line
of
protection
against
unscrupulous
prescribing. 

Next,
risk-based
patient
intake
procedures
can
help
trigger
red
flags
early.
That
may
be
like
cross-verifying
patient
data
for
“doctor
shopping”,
the
application
of
AI
to
identify
high-risk
drug
requests
pending
manual
review
temporarily. 

Transparency
is
similarly
important.
Patients
need
to
be
told
how
the
prescribing
decisions
are
being
made.
Clinical
guidelines
or
marketing
figures?
Is
the
site
providing
after-care
of
just
the
prescription?
Ethically
run
sites
will
have
decision-making
priorities
mirror
standards
of
face-to-face
care,
not
shortcuts. 

Critically,
telehealth
companies
should
not
only
be
relying
on
automation.
AI
can
definitely
supplement
safety,
but
they
must
supplement-not-replace-clinical
judgement.
Real
practitioners
should
screen
each
prescription,
particularly
for
controlled
or
high-risk
medication.

Looking
ahead:
Responsible
growth
in
digital
health 

The
future
of
telehealth
is
trust.
As
the
market
matures,
all
parties
—
providers,
regulators,
and
platforms
—
must
collaborate
to
sustain
that
trust. 

We
will
see
more
stringent
standards,
both
federal
and
state
medical
boards,
and
additional
industry-led
efforts
to
establish
voluntary
compliance
standards.
Solutions
such
as
third-party
platforms
or
certification,
public
quality
ratings,
and
transparency
for
prescribers
will
define
the
next
page
in
digital
care. 

Most
importantly,
patient
education
will
be
critical.
By
helping
consumers
recognize
the
difference
between
genuine
services
and
“too
good
to
be
true”
pill
mills,
we
can
dissuade
demand
for
black-market
alternatives
and
encourage
informed
decision
making.

Photo:
Feodora
Chiosea,
Getty
Images

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