1. Nathaniel Lacktman, Esq. @Lacktman
Legal and Business Issues in Telehealth: Offering Services in Michigan and Beyond
Nathaniel Lacktman, Esq.
@Lacktman
June 8, 2017

3. Telehealth Sources of Revenue
Government FFS (Medicare, Medicaid)
Cost Savings and Cost Avoidance
Medicare Advantage, Medicaid MCOs
Telehealth Sources of Revenue
Self-Pay / Cash
Commercial Health Plans
Institutions, Providers
Employer Self-Funded Plans
Employer Pay (OOP)

4. Telehealth: Think Bigger

5. Services + Credentialing
Payment + Reporting
Originating Site
Distant Site
Services + Credentialing

6. Originating Site
Services
Recurring
FFS
Distant Site

7. Statewide Telemedicine Network

8. Nationwide Destination Medicine Center

9. International Telemedicine Arrangements

10. Legal & Regulatory Considerations

11. Telemedicine State Practice Standards
New Patient vs. Established
In-Person Exam
Originating Site Restrictions
Patient-Site Telepresenter
Modality of Communication Technology
Remote Prescribing (incl. Controlled Substances)
Record-Keeping and Record-Sharing
Informed Consent
Patient Choice of Provider
Disclosures
Malpractice & Professional Insurance Considerations
Credentialing
Michigan
Consent? yes
In-person exam? no
Prescribing and CS? yes
Available for follow-up care? yes
Records? No
Modality? “Telemedicine” is defined as the use of an electronic media to link patients with health care professionals in different locations. The health care professional must be able to examine the patient via a real-time, interactive audio or video, or both, telecommunications system and the patient must be able to interact with the off-site health care professional at the time the services are provided.

12. Beyond In-Person Exams
U.S. Federal
Anti-Kickback Statute
Physician Self-Referral
Civil Monetary Penalty Law
Payer Rules (including Medicare, Medicaid)
HIPAA & HITECH
FTC, FDA, DEA
Credentialing
U.S. State
Patient Brokering Acts
Fee-Splitting Laws
Self-Referral Laws
Corporate Practice of Medicine
Insurance Laws
eCommerce Considerations
Privacy & Security
International
Foreign Corrupt Practices Act
US Export Control Laws
US Anti-Terrorism Laws
US Anti-Boycott Laws
International Corporate Laws and Tax
Data protection; data ownership; record sharing
Intellectual Property

13. One Law Firm. All Your Digital Health Needs.
Nathaniel Lacktman, Esq.
Partner
Chair, Telemedicine Industry Team
Co-Chair, Digital Health Group
@Lacktman
Telemedicine ● Telehealth ● Virtual Care ● mHealth
Fraud and Abuse ● Regulatory Compliance ● International/Destination Medicine
Reimbursement and Payment ● Contracting and Joint Ventures ● M&A
Licensure and Practice ● Concierge Medicine ● Privacy and Security

14. Thank you