Fee sharing, telehealth raise medical marijuana questions
As the number of patients approved to use medical marijuana in Florida continues to climb, some providers are growing increasingly frustrated by what they allege are bad actors in the state’s highly competitive cannabis industry.
One of the issues involves online companies seeking to make it easier for people to qualify for medical marijuana by connecting patients and doctors. The businesses share a portion of fees with physicians, who sometimes conduct patient evaluations through telehealth.
The fee-sharing agreement could run afoul of a state law prohibiting patient brokering. And a separate law requires doctors to meet in person with patients seeking medical marijuana.
The activities are drawing the ire of doctors spending money and time to comply with what is deemed to be one of the nation’s most rigorously regulated medical marijuana programs.
Nearly 2,300 Florida doctors have undergone training that allows them to order medical marijuana, which was broadly legalized by state voters in a 2016 constitutional amendment. A number of physicians belong to practices that focus almost exclusively on cannabis patients. The state has more than 730,000 patients who’ve qualified for the treatment.
Online businesses such as Veriheal are gaining a foothold in Florida and other states by promoting services for patients interested in getting state-issued medical-marijuana cards.
“Veriheal is a healthcare technology company with a mission to provide personalized cannabis education and wellness to everyone around the world. We do that by connecting patients and doctors online, through our platform, to provide recommendations for living a better life,” the company’s website says.
Veriheal, a corporation registered in Delaware with a physical address in Colorado, charges $199 to hook up patients with doctors and help navigate the process to obtain Florida cards. The money is refundable if patients don’t qualify for the treatment.
According to a complaint filed with the Florida Board of Medicine in February, Veriheal enlisted doctors to participate in its referral program by offering physicians $55 for each patient steered from its website. Doctors wouldn’t receive anything if the patients were deemed ineligible for medical marijuana, according to the complaint.
Critics question the legality of such fee-sharing agreements.
State law says, in part, that it is unlawful to “offer or pay a commission, benefit, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, to induce the referral of a patient or patronage to or from a health care provider or health care facility.”
Aaron Bloom, CEO of DocMJ, filed a petition asking the Board of Medicine for a “declaratory statement” to determine whether a proposed Veriheal fee-splitting agreement violated Florida law, after the company solicited a doctor who works for Bloom’s group.
“The statute is so clearly written that it basically says nobody — persons, companies, anything — can pay anything of value for a referral,” Bloom, an attorney, told The News Service of Florida in a phone interview.
The board addressed the issue at an April 8 meeting in Tampa.
“You’ve answered your own question when you referred to it as a split fee,” board attorney Ed Tellechea told Bloom, whose company contracts with 45 doctors throughout the state.
But Tellechea said the board, which can issue sanctions against doctors, lacked authority to punish the online company. The anti-kickback law gives the attorney general’s office and state attorneys the power to prosecute illegal fee-splitting arrangements.
In a series of emails last week, a spokesman for Veriheal said the company could not respond to questions about its Florida activities due to the holiday weekend.
Some doctors working with Veriheal and similar companies also have conducted patient consultations via telehealth. State law requires doctors to be “physically present in the same room as the patient” and to conduct physical examinations when evaluating whether patients are eligible for medical marijuana.
Gov. Ron DeSantis temporarily suspended the face-to-face requirement because of the COVID-19 pandemic, but only for patients who were renewing medical-marijuana certifications with the same doctors they had seen previously.
The executive order expired a year ago, and the state Office of Medical Marijuana Use’s website advises doctors that telehealth is off-limits.
“As of June 27, 2021, the use of telemedicine services to re-certify existing patients in the Medical Marijuana Use Registry is no longer allowed,” the office’s FAQ for physicians says.
But some doctors continued the practice, according to information obtained by the News Service.
For example, Ivan Fields, the CEO of marijuanadoctor.com, had a telehealth visit on March 4 with Ahsan Iqbal, a doctor he was referred to by Veriheal. The session lasted just under five minutes, a recording of the meeting provided to the News Service showed.
Florida law also requires doctors to perform a number of steps before certifying that patients are eligible for medical marijuana. Doctors have to enter information about the patient into a statewide database. The data includes the patient’s qualifying condition, dosage and the amount and forms of marijuana authorized for use.
When Fields asked Iqbal — whose voice can be heard in the recording but whose camera was off throughout the visit — about what products he should use, the doctor told him he would receive information from Veriheal or medical-marijuana dispensaries.
“You have nothing to worry about. All my patients get anything at the dispensary,” Iqbal told Fields. “We take care of everything and make it very simple, so you have access to everything possible at the dispensary.”
Iqbal did not respond to an email seeking comment.
Fields, whose company contracts with doctors in 35 locations, never followed up and did not try to obtain a marijuana ID card.
Emails obtained by the News Service showed that Veriheal was continuing to solicit doctors to conduct telehealth certifications as recently as last month and scheduling online patient consultations through June.
For example, a May 4 message from Veriheal to a Florida doctors’ group said Veriheal was “back online for Florida telemedicine for initial consults.”
A May 31 email showed that Veriheal booked a June 2 telehealth appointment for a prospective patient with “Dr. Cannabis Consultants LLC.”
“Step 1: Prepare for your video appointment and complete your consultation,” said part of the message from “Warren” at Veriheal.
In a May 21 press release, Veriheal announced that it had “reasserted its commitment to the Florida medical cannabis market by partnering with over 20 healthcare providers in the Sunshine State.”
The Florida Department of Health did not respond to questions about the telehealth or patient-brokering allegations. Attorney General Ashley Moody’s office did not say if she was aware of the complaints.
Bloom said he believes the vast majority of doctors “are doing it right and want to do it right.” But he and other industry executives are frustrated that their complaints about alleged rule breakers aren’t getting results.
“We as an industry are trying to stop this ourselves and police it ourselves. And nobody, unfortunately, wants to help us,” Bloom said. “I do think there needs to be a mechanism for the existing government agencies to enforce the law.”
Bloom also is concerned that wrongdoers could undermine the credibility of the medical-marijuana program.
“It’s incredibly frustrating for our doctors. Our doctors, they love the program because they see the amazing benefits and results that their patients are getting,” Bloom said. “What’s particularly confounding to our doctors is that there are so many rules and regulations and this program is under such scrutiny. Every year, the Legislature continuously looks for ways to regulate it. … Why is this issue, a clear violation, ignored?”