A telemedicine contract may describe chart reviews, consultations, or remote patient care. Federal investigators may describe the same work as a system for converting marketing leads into reimbursable orders.
The difference rarely turns on the word “telemedicine.” It turns on what the practitioner knew, what clinical information was available, whether the patient was meaningfully evaluated, how compensation worked, and where each order went after it was signed.
At Keith & Lorfing, we defend physicians, nurse practitioners, marketers, owners, and other professionals facing federal health-care investigations.
If you are under investigation for telemedicine fraud, false claims, kickbacks, medically unnecessary orders, billing misconduct, or another federal healthcare offense, speak with a healthcare fraud defense lawyer before responding to investigators, auditors, or government requests.
Telemedicine is legal—the alleged scheme is the issue
Telehealth is a lawful and important way to deliver care. A federal case generally begins when the government believes the technology was used to generate orders, prescriptions, or claims without genuine clinical decision-making.
The government may trace a chain involving:
| Participant | Role investigators examine | Questions that may shape the case |
|---|---|---|
| Marketer or call center | Finding patients or generating leads | Were patients promised free items, coached, or selected because of federal coverage? |
| Telemedicine platform | Routing patients and records to practitioners | Did the platform provide real clinical information or direct a predetermined order? |
| Practitioner | Evaluating the patient and signing the order | Was there enough contact and information to make an independent medical decision? |
| Supplier, laboratory, or pharmacy | Filling the order and submitting the claim | Was the item delivered, medically necessary, covered, and properly billed? |
| Owner or payment recipient | Funding or profiting from the arrangement | Did compensation track referrals, orders, or federal reimbursement? |
The same person may appear in more than one part of the chain. A practitioner does not become criminally responsible merely because another participant committed fraud, but prosecutors may use emails, payment records, platform permissions, and repeated order patterns to argue knowledge and participation.
OIG’s telemedicine warning signs
The HHS Office of Inspector General issued a Special Fraud Alert about practitioner arrangements with telemedicine companies. The alert does not create a new crime, and no single factor automatically makes an arrangement illegal.
OIG identified characteristics that may justify closer scrutiny:
Lead generation: The company or its marketers recruited people through call centers, health fairs, or advertising for free or low-cost items.
Thin clinical information: The practitioner lacked enough contact or patient information to assess medical necessity.
Volume-based compensation: Payment correlated with the number of items or services ordered, even when described as payment for reviewing records.
Federal-program focus: The business served only federal beneficiaries or claimed to exclude them while federal programs were still billed.
Predetermined products: The company offered one product or class of products, restricting the practitioner’s treatment choices.
No follow-up: The arrangement did not expect practitioners to follow up or give them the information needed to do so.
These factors are evidence questions, not a checklist for automatic guilt. The defense should compare the alert’s concerns with the actual contract, platform workflow, patient records, compensation data, and practitioner communications.
An early internal review may also reveal facts the initial subpoena does not show, such as rejected orders, requests for more information, patient follow-up, or limits the practitioner placed on the platform.
A per-consult fee is neither automatically safe nor automatically illegal
A telemedicine company may describe compensation as a flat payment per chart, consultation, assessment, or completed encounter. The label does not decide whether the arrangement is lawful.
The federal Anti-Kickback Statute prohibits knowingly and willfully offering, paying, soliciting, or receiving remuneration to induce or reward certain referrals or orders involving a federal health-care program. It can reach both sides of an unlawful payment arrangement.
A per-consult structure can still create concern if nearly every review produces a preselected order, the practitioner is paid only for completed approvals, or the number of paid “reviews” tracks reimbursable items. A genuinely flat rate for legitimate clinical work may support the defense, but it does not create immunity by itself.
Relevant evidence may include:
Payment trigger: Whether payment depended on reviewing a patient, completing a consultation, signing an order, or the supplier receiving reimbursement.
Clinical independence: Whether the practitioner could reject the suggested item, choose another treatment, or require an in-person examination.
Access to records: Whether the platform supplied meaningful history, diagnostic information, and prior treatment records.
Downstream knowledge: Whether the practitioner knew which supplier would fill the order or how the claim would be billed.
Volume pressure: Whether quotas, scorecards, response-time demands, or termination threats encouraged approvals.
The statute requires knowing and willful conduct. A compensation model that looks suspicious in a spreadsheet still must be connected to the required intent and covered referrals or orders.
Medical necessity must be evaluated claim by claim
“Brief telehealth visit” and “medically unnecessary order” are not synonyms. The necessary evaluation depends on the condition, item, available records, applicable coverage criteria, and professional standard of care.
The government may focus on identical notes, missing patient contact, orders that do not match reported symptoms, or a pattern in which almost every encounter ends with the same product. The defense may focus on the actual clinical information, documented reasoning, rejected requests, follow-up instructions, and variations among patients.
Medical necessity and program coverage are also different questions. A clinician may believe an item could help the patient, yet the claim may still fail a Medicare documentation or coverage requirement; that does not by itself prove a criminal scheme.
The federal charges require different proof
Telemedicine investigations can produce criminal, civil, and administrative exposure. The government must prove the elements of each theory rather than treating every unusual order as one general offense.
Our healthcare fraud defense attorneys examine the alleged billing scheme, practitioner conduct, compensation structure, medical-necessity evidence, referral relationships, and resulting claims before determining which legal theories the evidence actually supports.
When the investigation focuses on billing codes rather than the legality of telemedicine itself, the case may involve allegations that services were billed at a higher level than supported or separated into charges that should have been billed together. Our upcoding and unbundling defense page explains how these allegations are evaluated and why the defense often depends on documentation, coding rules, medical necessity, and intent.
| Allegation | What the government must generally prove | Maximum statutory exposure |
|---|---|---|
| Health-care fraud under 18 U.S.C. § 1347 | Knowing and willful execution or attempted execution of a scheme involving a health-care benefit program | Ordinarily 10 years; higher maximums apply if serious bodily injury or death results |
| Health-care fraud conspiracy under 18 U.S.C. § 1349 | Agreement to commit the underlying fraud, knowledge of the agreement, and voluntary participation | Same statutory penalties as the underlying Chapter 63 offense |
| Anti-Kickback Statute | Knowing and willful remuneration to induce or reward covered referrals, orders, or recommendations | Up to 10 years and a fine of up to $100,000 per violation |
| Wire fraud under 18 U.S.C. § 1343 | A scheme to defraud, fraudulent intent, and use of interstate wires in furtherance of the scheme | Ordinarily up to 20 years |
| Money laundering under 18 U.S.C. § 1956 | A qualifying financial transaction involving proceeds of specified unlawful activity plus the required statutory purpose or knowledge | Up to 20 years |
| Civil False Claims Act | A knowingly false claim, material false record, or knowing avoidance of a repayment obligation | Three times the government’s damages plus inflation-adjusted per-claim penalties |
The ordinary statutory maximum is not a prediction of sentence. Charging decisions, loss calculations, role, criminal history, the advisory Sentencing Guidelines, and the court’s findings all matter.
Section 1349 does not require an overt act
The original work performed by a practitioner may be lawful, so conspiracy cases often turn on whether the person knowingly joined the alleged agreement. In the Fifth Circuit, the elements of a health-care fraud conspiracy are the agreement, knowledge of it, and voluntary participation.
Section 1349 does not add an overt-act requirement. Presence in the business, payment for legitimate work, or association with people who later committed fraud is not enough by itself, but knowledge and participation may be inferred from surrounding facts.
False Claims Act exposure is civil but serious
The False Claims Act uses a civil knowledge standard that includes actual knowledge, deliberate ignorance, and reckless disregard. It does not require proof of specific intent to defraud.
A practitioner may face a claim that an order caused a supplier or laboratory to submit false claims even when the practitioner did not personally bill Medicare. The defense may dispute falsity, materiality, causation, knowledge, medical necessity, or the scope of the alleged claim universe.
Three rulebooks can apply to the same virtual visit
One of the most common mistakes is treating all “telehealth rules” as one set of requirements. Medicare payment policy, controlled-substance prescribing rules, and Texas professional standards answer different questions.
Medicare telehealth payment rules
CMS’s February 2026 telehealth guidance states that, through December 31, 2027, Medicare beneficiaries may generally receive covered telehealth services anywhere in the United States and its territories. The guidance also addresses eligible practitioners, audio-only services, place-of-service codes, and other billing details.
Those access flexibilities do not authorize medically unnecessary items, kickbacks, false documentation, or billing for a service that was not provided. A defense should use the rule in effect on the service date and connect it to the exact code and claim.
DEA controlled-substance prescribing rules
DEA’s separate temporary flexibilities concern prescribing controlled medications without a prior in-person medical evaluation. The fourth temporary extension continues specified flexibilities through December 31, 2026, subject to federal and state requirements.
DEA compliance does not establish that a Medicare claim was payable, and Medicare telehealth coverage does not establish that a controlled-substance prescription complied with DEA rules. The two systems should not be treated as interchangeable.
When the investigation centers on allegedly unnecessary or improper controlled-substance prescribing, the case may also overlap with federal pill mill allegations, which raise separate questions about prescribing practices, practitioner intent, patient care, and drug-distribution laws.
Texas practitioner-patient and standard-of-care rules
Texas law supplies another layer. Chapter 111 of the Texas Occupations Code addresses when a valid practitioner-patient relationship may be formed through telemedicine and requires the same standard of care that applies to the comparable in-person service.
The law also addresses access to relevant clinical information and follow-up duties for certain telemedicine relationships. Licensure, scope-of-practice, prescribing, consent, and record rules may apply in addition to the federal payment and criminal statutes.
Compliance with one rulebook does not cure a violation of another. It can, however, defeat an allegation that depends on an inaccurate view of what the governing rule required at that time.
Building the defense around what the practitioner could see
The government often reconstructs the arrangement from the top down: money from the supplier, leads from the marketer, orders from practitioners, and claims to the program. A practitioner may have seen only one narrow part of that system.
A defense review may ask:
What did the contract disclose? Identify the represented service, payment terms, clinical duties, and compliance promises.
What did the platform display? Preserve the patient record, prompts, default choices, audit trail, and practitioner permissions.
What could the practitioner reject? Document declined orders, requests for more information, escalations, and alternative treatment decisions.
What happened after signature? Determine whether the practitioner knew the supplier, product, price, payer, or final billing code.
How was compensation calculated? Compare the written terms with invoices, bank records, completed encounters, rejected encounters, and actual orders.
What guidance existed then? Match Medicare, DEA, state-law, and platform requirements to the service date.
Good-faith reliance on accurate information may matter, but a contract cannot erase facts the practitioner actually knew. Likewise, a compliance opinion based on incomplete or misleading facts may provide little protection.
What to do after a subpoena or agent contact
Do not try to make the records look better. Preserve them as they existed, including contracts, schedules, patient files, platform messages, compensation data, rejected orders, credentialing records, training material, and communications with company personnel.
Then:
Identify who contacted you: A contractor request, OIG subpoena, grand jury subpoena, civil investigative demand, and licensing-board inquiry require different responses.
Do not improvise an interview: A mistaken answer about a platform you did not control may later be compared with data you had never seen.
Clarify representation: Company counsel represents the company unless counsel has separately agreed to represent you and conflicts have been addressed.
Preserve deadlines: Record-production, appeal, and licensing deadlines may run while the criminal risk is still unclear.
Avoid witness coordination: Do not contact other participants to align accounts or discuss what they should tell investigators.
Stop routine deletion: Preserve emails, texts, portal data, device records, and cloud files that may otherwise disappear.
A subpoena or target letter is not a conviction. Early federal investigation defense can define the person’s status, control communications, and identify evidence that may not appear in the government’s first version of events.
West Texas defense for telemedicine allegations
Keith & Lorfing focuses its practice in West Texas, with offices in Abilene, Lubbock, Midland, and San Angelo. Russell Lorfing previously served as a federal prosecutor in Lubbock, and our team includes multiple former federal and state prosecutors.
Our attorneys have more than 75 years of combined experience and more than 500 jury trials. We use that trial background to test whether the government can connect a practitioner to the alleged agreement, improper payment, false order, and resulting claim.
If you are facing a subpoena, target letter, audit, or agent interview involving telemedicine, call (325) 480-8100 or contact Keith & Lorfing for a free consultation before responding.
Frequently asked questions
Is telemedicine illegal?
No. Telemedicine is a lawful method of providing care, and federal programs reimburse many properly delivered and documented telehealth services.
Fraud allegations concern conduct such as unnecessary orders, false claims, kickbacks, fabricated records, or knowing participation in a scheme—not the technology itself.
Does a flat per-consult fee prevent an Anti-Kickback Statute charge?
No. A flat rate may be relevant, but investigators examine what triggered payment and whether the fee tracked federally reimbursable orders or referrals.
The clinical work, compensation formula, rejection rate, downstream knowledge, and parties’ intent should be considered together.
Can I be liable if I did not submit the Medicare claim?
Potentially. Federal criminal and civil laws can reach people who cause false claims or knowingly join a fraud or kickback arrangement, even if another company submitted the bill.
The government must still prove the elements that apply to that person. Lack of access to billing, limited knowledge of downstream conduct, and genuine clinical work may be important defense evidence.
Did the COVID-era telehealth rules end?
The answer depends on which rules you mean. Current CMS guidance extends several Medicare telehealth flexibilities through December 31, 2027, while DEA’s fourth temporary extension for specified controlled-substance prescribing flexibilities runs through December 31, 2026.
State professional rules continue to apply. The correct analysis uses the rule governing the particular service, prescription, location, and date.
Does a telemedicine fraud charge automatically end my medical license?
No. A criminal investigation or charge does not automatically produce the same licensing result in every case.
It may trigger a board inquiry, reporting duty, credentialing issue, payer action, or federal-program exclusion question. Those consequences depend on the jurisdiction, procedural stage, and underlying conduct.
How long does a telemedicine fraud investigation take?
There is no reliable universal timeline. The scope of records, number of participants, claim volume, agencies involved, and whether the matter includes a sealed civil case can all affect its length.
The absence of immediate charges does not mean an inquiry has ended. Counsel can seek information about the client’s status while preserving evidence and preparing for the next stage.
