Telehealth Physician Board Order: Licensed Nationwide, an Inadequate Patient Relationship

The Mississippi telehealth board order found that a physician’s questionnaire and instant-message encounters failed to establish an adequate patient relationship, despite the physician holding licenses in all states and the District of Columbia. The credentialing file covered the country. The clinical work still had to hold up for the patient.

The board issued its corrected determination on May 18, 2023. It addressed conduct under Mississippi’s older rules.

Mississippi Restricted Telehealth Practice

The Mississippi order imposed a three-month suspension and immediately stayed it, putting that suspension on hold. Separately, it prohibited telehealth practice through June 17, 2023. The conduct preceded Mississippi’s July 26, 2022 rule amendments, and the board applied the older rules.

The Reciprocal Order Followed the Mississippi Action

The North Carolina Medical Board’s September 6, 2023 consent order imposed reciprocal discipline based on the Mississippi action and required compliance. It also imposed a three-month suspension that was immediately stayed.

The later consent order also set out a rule against treating a patient or prescribing medication solely from an online questionnaire. That brings the focus back to the clinical exchange: the information a patient submitted and the evaluation behind the prescription.

What Nationwide Licensing Can Tell a Telehealth Business

A 2015 commentary in the Journal of American Physicians and Surgeons, FSMB Interstate Medical Licensure Compact: An Economist’s View, challenged the connection between expanding licensing machinery and improving care. The compact’s stated purpose was to speed applications for physicians seeking to practice across states.

The commentary also questioned the economic case for placing oversight in the state where the patient is located. For a telehealth operator, the useful distinction is concrete: permission to work across state lines and the care delivered within an encounter need separate evidence.

Where the Clinical Workflow Becomes Visible

For an insider, the useful comparison is between what the clinician saw and what the clinician decided. The questionnaire, the message exchange, the assessment and the resulting prescription each describe a different part of the care. We examine how those parts fit together, including what clinical information was available when the decision was made.

A clinical employee may know what information the doctor could see. An operations employee may know how questionnaires and messages moved through the platform. A billing employee may know which service the company represented to the payer. Connecting those views can show the difference between the workflow as sold, the care as delivered and the service as billed.

The same relationship issue appeared in a later Mississippi consent order involving Hello Alpha. In that separate matter, a different physician admitted facts involving an inadequate relationship through store-and-forward care and questionnaires. Store-and-forward means that information is submitted for later review. The parallel is the clinical work behind the exchange: what the physician reviewed and what relationship that review established.

Management arrangements also matter to understanding who controlled the work. In the telehealth industry, staffing, scheduling, billing, collections and custody of medical records can sit with a management company while a professional entity provides health care. We look at the actual allocation of those responsibilities when an insider describes how a practice operated.

The Whistleblower Question Is What the Claim Represented

This case’s outcome was professional discipline. In a telehealth whistleblower matter, we also examine the connection between the clinical work and the payment sought for it. When a business bills for care it did not deliver, the patient loses the care and the payer pays for it.

The encounter record can show what the practitioner reviewed. The signed order or claim can show what someone represented about an examination, a patient relationship or the need for treatment. An insider’s knowledge can connect those representations to the decisions inside the business.

The payment can also sit beyond the encounter. In a separate July 20, 2022 fraud alert, the Office of Inspector General described arrangements in which companies recruited patients and practitioners, supplied information, paid for reviews or signatures and transferred the resulting orders to downstream buyers. That gives an insider another part of the transaction to recognize: who wanted the signed order, who paid for the review and where the order went. We examine that connection alongside the clinical work and the claim it supported.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. For a healthcare employee who knows how the clinical record and the bill diverged, we assess that connection and the potential case with them.

You Know What Happened Between Intake and Prescription

If you saw a telehealth business turn questionnaire reviews into claims for care the clinical work did not support, speak with our whistleblower experts. We build the case around your knowledge of the encounter and the payment, bring in telehealth fraud whistleblower lawyers who understand remote prescribing and billing, and stay beside you through the case.