Hosts Dr. Leo Damasco and Phoebe Gutierrez dive into August's top telemedicine stories: a judge pausing ACA marketplace changes from the "big beautiful bill," rising scams targeting doctors with "digital arrest," a bizarre case of a software engineer juggling multiple jobs, and the looming expiration of telehealth flexibilities. Essential updates for telemedicine providers navigating policy shifts and risks.
What could happen if key ACA marketplace rules kick in, leaving millions without coverage?
In this end-of-month recap episode of Telemedicine Talks, hosts Dr. Leo Damasco and Phoebe Gutierrez break down the latest developments in telemedicine and healthcare policy for August 2025. They discuss a Maryland judge's August 22nd decision to temporarily block parts of the Marketplace Integrity and Affordability Rule—set to start August 25th—including a $5 minimum premium, stricter income verifications, and repayment enforcements, which could disenroll over 2 million people. The conversation explores the human impact, especially on low-income individuals just above Medicaid thresholds (e.g., $15,000–$16,000 annually in many states). Shifting gears, they highlight international reports of "digital arrest" scams targeting telemedicine doctors, where fraudsters impersonate officials to extort money via threats of warrants or lawsuits. Leo shares personal stories of similar scams affecting him and his wife, emphasizing the need for vigilance. They also touch on a quirky case of a software engineer caught working 140 hours a week across multiple tech jobs by outsourcing tasks, drawing parallels to telemedicine moonlighting risks and NDAs. Finally, they provide an update on COVID-era telehealth flexibilities expiring September 30th, 2025—including rural restrictions, audio-only coverage, and Ryan Haight Act waivers for controlled substances—urging preparation amid lobbying efforts by groups like the ATA and AMA. This episode is vital for telemedicine practitioners facing potential disruptions in access, reimbursement, and operations.
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[00:00:00] Everybody welcome back to telemedicine talks. as always, we got the wonderful Phoebe Gutierrez. Hello and the average me. Hi everybody. Well, um, no. Um. Thank you again for joining in. It's about that time at the end of the month that we like to throw some, like our monthly recap, getting some interesting stories out there out, from the interwebs and bring it to you and hopefully you find it interesting and pertinent to, what you're doing.
Phoebe, take it away. Hey everyone. End of the month, sometimes we talk regulatory stuff, sometimes we talk, current events. we picked just a few stories that I think are, super relevant for the month. it's a little different flavor than what we normally share, but,so one of the things that I think is really, of course everybody knows I care so much about, like.
The government programs and how all of that works. But,some people, many people didn't know that there were gonna be some key marketplace rules, connected to the Affordable Care [00:01:00] Act, mainly with the passage of the big beautiful bill that were going to really drive certain, price hikes and,Currently, a judge has officially paused some of the key changes. So on, pulling up my notes here, but, e just this week, August 22nd, um, judge in Marilyn temporarily blocked some key. Parts of the marketplace integrity and affordability rule. and those were actually set to take place August 25th.
that is, again, a mixture of health and human services, CMS. and really the idea was this is a way to protect, quote unquote the integrity of the marketplace. Some of those provisions were, the $5 minimum premiums. you'd have to be required to pay at least $5 a month, which would be a pretty big change.
Some stricter income verifications. We've already, talked a little bit [00:02:00] about that. they were actually gonna be doing some, like integrations in terms of matching. So if your income didn't actually match what was reported to the IRS, and then just like repayment, enforcement, so.
A lot more, tighter rules around the collection process. and so part of that was blocked, for the simple fact that, it, it's reported that over 2 million people would be losing access to care because of some of these key changes. And because of that, you're really trying to factor in the human harm versus, the potential.
You know, I don't know what you even wanna call it, protections that they're claiming that these, changes are gonna make . And,ultimately,it's not really just about the $5 fee. It's, really like millions are gonna lose coverage. And because of that, a judge stepped in and said, you're gonna basically be, doing irreparable harm by, enforcing these things.
Yeah, [00:03:00] no, that's, we talked about this before, right? and, in, in the name of, integrity and cost savings, the concern was yeah, a lot of people, especially low income right, would lose their access to healthcare, right? And, some provisions like a $5 monthly fee, and that may not seem a lot to most people.
But yeah, that, that could be, cost inhibitory for many of the population out there. and it's funny because a lot of this was based on kind of the lower income and the people that actually really need this service. So one, I think it's refreshing to see that, they're gonna take another look at it.
they're pausing these potentially detrimental, provisions. So another thing that we talked about, that you talked about before was these special enrollment periods that you could only enroll at this time. And like life. and especially in this population, they may not have the time, it's, a lot of other priorities other than filling out paperwork is involved.
did they [00:04:00] talk about how long is this indefinite or. do this is gonna come around the table or is this just a, just pushing, just pushing the rock down the road kind of thing? it's definitely pushing the envelope down the road. I think that you're gonna have another judge that's going to, throw this one out.
Yeah. but ultimately I think, one key distinction that I think people don't quite understand is, and I'm, I'm just gonna try to put this into perspective. So in order to qualify for Medicaid in many states, you have to meet what's called federal poverty level, Is it level or limit?
It's one of those, one of those Ls. But basically you have to meet this like certain income threshold, and it is low. It is a very small amount. So you know, California, it's 138%. A lot of states, it's 138%. That equates to about $15,000 a year that one person makes. So imagine if you're in the bucket and you make [00:05:00] 16,000, that means 16,000.
You have to go through this a CA marketplace, and that $5 is going to make a big difference. Oh yeah. Absolutely. and it's in law. it is a legal requirement. You not have health insurance. And part of it is am I gonna pay the penalty because I don't have health insurance ?
Do I pay? And, you know, I, these plans, even at the lower income, you're paying 200, 300, $400 a month. And then on top of it, the five bucks,. It turns into something I think that people don't quite understand. I think a lot of people try to think either you get Medicaid or you're, you know, you're well off and you can go through a marketplace, but there is that line and it is a really low bar that you have to meet to, just be over that income threshold.
Yeah. Yeah. and you're right. it makes a big difference to a lot of people now. It's funny, I was just reading up on this and, it,there was a positive effect . [00:06:00] Right now, people are really happy about this. it was funny that stocks surged up for like insurance companies and whatnot as well.
definitely positive effects. it's gonna be interesting to see,how quickly this turns around and how far we could push it down the road as well. and hopefully cooler heads prevail. yeah. Yeah. And,
so the next story that I thought, as I read, I totally thought of you and I should have actually prank called you, was, there have been a lot of reports in a, in, this month,coming from out of the country, other countries. But basically saying that doctors are being scammed, typically telemedicine doctors, so virtual care doctors, and they're called, they're being put under what's called digital arrest.
So scammers are using like a blend of different tactics. They're saying that there are arrest warrants out against certain doctors. They are continuously calling doctors. They're [00:07:00] impersonating officials. they're, saying that they're going to, prosecute them. They're telling them to go turn themselves in at, different police stations.
they're holding them almost captive until they give them what they want. imagine you're a doctor and somebody calls you and says that, I'm gonna file a malpractice suit against you because you did X, Y, and Z, and yada, yada. And I am, calling from the State Department of Georgia and, you need to, do these things.
and the, some doctors are, falling for this because they, the fear of a lawsuit, the fear of a, a complaint, the fear of something.
currently these reports are coming from overseas and there's.
A lot of fear saying that, potentially they're gonna start in the United States or, I don't know, Leo, maybe they've already started actually, it's funny you mention this and when you brought this up, gosh, this is, this definitely hits home. My wife and I were actually targeted, with a couple scams and it's separate [00:08:00] scams, this was about six months ago, and somebody called my wife.
And was saying that, Hey, you didn't file some sort of licensing paperwork and oh no, it was a Medicaid thing and you didn't file this correctly. You're gonna have to pay up and if you don't pay, you're gonna get arrested. People are gonna come at your place of business. and they called her personal phone number.
Actually, they called the office that she was working for, asked for her, and the office at the MSA at that point gave the number to that person who then called her personal number. And after a few hours of just stressful times and trying to figure it out and actually calling the board, they were like, oh yeah, that's a scam for sure.
then we were just relieved and we just ignored further calls and they stopped calling. But [00:09:00] then about three months ago, I personally got a call, and there was somebody talking about I didn't pay some sort of, I forget, it was some medically related fees and that they, there's a warrant out for my arrest and they're gonna come get me.
And actually. I took this call, while I was picking up my kids and my poor daughter heard this call. she heard the person over the phone and, they were being actually pretty aggressive. They were being pretty aggressive. at first it started out as, Hey, we just wanted to let you know you have this warrant out.
you could either pay now or you're gonna get arrested. at that point in time, my daughter was like, oh my god, daddy, are you gonna get arrested? I was like, no, we're not getting arrested. And so I actually switched it onto my, off the car mode and onto my personal cell phone and just talking and, I was like, Hey, I don't get it.
And they were just getting more and more aggressive. And, they were trying to keep [00:10:00] me on the line, like you said, they were just trying to freeze me. And the threat they made the threat. They were like, Hey, we're gonna send a cop. To come and get you where you are. And I was like, oh, crap.
my house is right next to a police station. I was like, I'm gonna turn myself in, if, whatever, if something's happened, then I'll turn myself in and we'll figure this out. And that's when.
They started backing it up. They're like, oh no, you really want to turn yourself in. How about you just pay money? it's just gonna be easier that way. And then that started c clueing me in. I was like, oh no, this is different. You know what I mean? I, this is probably scam, where there was a sense of hesitancy.
'cause you know a lot of the audience out here, right? telemedicine doctors that are getting all their licenses that are working across the board. There's some, sometimes you don't know where your information is and it could just be floating out there. And with your information all out there, especially if you're practicing in 50 states, across different companies, this may actually sound believable.
there you're not [00:11:00] fully a hundred percent knowledgeable of what's what your information's doingand. In my head, I was like, I do things by the book. I'm pretty good, but what if I slipped a little? what if I missed? What if there was something I didn't know that I didn't do?
And what if I'm really in trouble? And, that's carrying where the hesitancy came from. looking back it was like, fuck you idiot. That was definitely a scam. That's, how'd you fall for that long? And honestly, it was like 30 minutes on the phone, right? Usually I'm just like, whatever.
See you later. Bye. But why did I actually entertain that? it's because, yeah, it's with the change in how I work and my information out there, part of me was like, oh man, is this believable? Is this not? yeah, be careful out there folks. there people are preying on you and.
Yeah. definitely second guess things, confirm it. yeah. that's scary stuff. Yeah. I think it's interesting 'cause like I think we, we've all been there where we've gotten like a text message or a phone call. Yeah. It's like I'm the [00:12:00] IRS and we're gonna call the cops.
And again, like I was working, I remember I was still working at the state. I had a manager. And he started freaking out. He is like, the IRS is, you know, and I'm like, you know, is it older? yeah. And I like, read the voicemail because it was, he le they left a voicemail and you got to see the transcription and it was like, it literally, the language didn't even sound legitimate or professional.
okay, you need to just calm down, but like, how many, we know this Leo, like doctors are fearful people. Absolutely. Doctors are. Risk adverse. they don't wanna break the rules. they really wanna make sure that they protect their licenses. And the last thing you want is you get a phone call from somebody who you think is an official also, it's really hard to call the actual department back.
And but I think like best practices, just in case anybody needs to hear this, any state agency that is coming after you has to. Send you something [00:13:00] in the mail. It is part of the federal regulation package for all state agencies. That's why like license stuff comes in the mail.
if you've ever got a board complaint, like hopefully none of you have. But if you have, you don't get a phone call. You get a piece of paper in the mail that's explaining what the complaint was. So that is just like a consistent thing across all, state agencies, different boards.
don't fall for this stuff. yeah. it's wild out there. how many scam artists there are and how many people actually fall for this . Definitely. And look out for red flags. Red flags are, cold calls like you said. They're gonna need provide, they're gonna need to provide written documentation.
and a written footprint . So if you get a cold call and say, Hey, you owe me money. You owe me money now, or you're gonna get arrested, definitely put the red flags out there, and really the valid complaints. We'll give you a chance to fight back. We'll give you a chance to [00:14:00] look into it and ask questions.
that's another red flag. they want. Money now. they want restitution now. and zealot, we want you to zealot. exactly. I want it now and I want it untraceable and Oh yeah. Don't forget to make me a friend on Zeal so I don't get taxed on the transfer.
Right. Like, come on now. and it's funny 'cause doctors are inherently smart people. But you're right. we're just so fearful. and so risk adverse that we are gonna be ready to fall for this when our livelihoods are threatened in this way.
Scary stuff. yeah. that's crazy . Don't fall for it. Don't fall for it. Yeah, don't fall for it. and then , the last story that I wanted to talk about before we just jump into some like key, you know, just like updates on, some regulations is, this I thought it was funny.
This is more like the, just like the digital health tech world. So there was this individual, his name is Sona Parika, [00:15:00] I dunno how to pronounce the last name, but let's say Sona. And, he was or is a software engineer, that admitted to working for multiple. Startup companies at the same time.
the funny part about it was he obviously knows how to interview really well because he is getting hired at all these 30 companies. Yeah. Like all these companies. And, the funny part was the companies that he was working for, some of them all had the same, Venture backed, VC company and so they, the VC actually started to put the pieces together and go, company A and company B and company F all have this guy as their software engineer like.
What is going on? Like, where's your conflict of interest? Where's your non-compete? Where's your NDAs? what's going on? he used multiple laptops, multiple VPNs, juggled calendars. the funniest part to me [00:16:00] was when he got caught, his strategy was like, you just be mediocre. You don't deliver anything early.
You do the bare minimum. you're not a rising star, you're not trying to get promoted. You're not, you're literally just trying to like do this. And I think the assumption was he probably had a team. So it was, him maybe running teams that were ultimately like doing the code, delivering stuff.
And he was just the face of who would get these interviews. Um, but to me I thought it was really funny because again, like when you're working virtually. A lot of companies, it's hard. You don't, you have no idea what your employees are doing. and I, it cracked me up because I know a lot of doctors that kind of do the same, do the same thing, in a different way.
he was W 2, 10 90 nine's very different. Yeah. But it really cracked me up, Especially you gotta be pretty ballsy to be like, all right, let's go after, let's go work for all the same companies that all have [00:17:00] the same investor. Yeah. And it's, looking at this article, yeah, it's like many backed by the Y Combinator vc, and it's, that's pretty big.
That's pretty widespread. and he was working 140 hours a week. How many hours are there in a week? Jesus Christ. Yeah. So 140 hours a week and he's probably working in a team. it, it reminds me of several stories, especially what I call the golden age, when, there were a bunch of people working on many different platforms and people were logging in hours that were just unreal, and maybe hours at the same time.
And there was question on whether or not that person was actually working that, or had, like you said, a team working on their behalf, right? definitely a big no-no. Definitely big no-no for doctors, right? the concern was who was the team? Was it med students?
Was it MSAs? Was it Joe Smo across the street? Was it their spouse? Who knows? Who knows, right? we definitely talk about [00:18:00] moonlighting and working as 10 90 nines, but definitely right there, there is a common sensical nature to this, you obviously be, can't be working, concurrently, just crushing multiple different platforms at the same
time. it just doesn't make sense and you . will get caught, right? and it's just honestly not good for patient care. Because if you're not fully focused, even if it is quick, relatively mindless kind of stuff, you're still not focused on patient care and it's gonna slip . So, um, yeah, definitely.
Yeah. 140 hours a week, Jesus Christ . it's funny too because I think, the key difference here that I'd like to say is, like I've been in operations role, right? I'm not writing code, I'm not really doing anything that's like super proprietary, in Yes.
Of some of the stuff, same thing with doctors, right? You're using independent clinical decision making. Like it's like a different, It's it's different. You are a software engineer, you [00:19:00] are a backend software engineer. You are writing the code to this proprietary thing that is getting built in the tech industry.
Yeah. you know behind the scenes. It is a war in the tech world. And you're talking about, ai, you're talking about health tech, you're talking about massive companies, massive, money flowing into this. And again, I think it's comical.
That one would be so ballsy, To think that you could potentially do this. I think the interesting thing too is I was reading that, he also kinda lied that he had a master's degree in computer science. part of this is was he just a really good you?
Interviewer that was able to like, almost like a salesperson, are you able just to get these jobs? And then you're outsourcing it to other engineers who are actually doing the work. Which [00:20:00] again, like just poses this question of, I just thought it was a really interesting story, considering Yeah, that's interesting.
it's funny though. just following up in what actually happened to this guy, another platform actually hired him. and another tech company hired him and was like, hell, this guy's very, very unique and, he's high powered. He's gonna work 10 times as hard,
so yeah, he's kind of turned into like a cult figure, I think that's been the thing of hey, like maybe his model's. Okay. again, I think in hindsight, this is how a lot of health tech companies are built today. They don't have in-house, no engineering teams.
A lot of them will outsource to these Engineering firms that'll go and build it until they have enough capital or investors to be able to pull an engineer. Engineers are freaking expensive. It is probably one of the outside of doctors, if you're doing anything like, they're building your [00:21:00] product.
in theory, there've been people who've urged him to, go build your own engineering company and oversee it. 'cause obviously you were able to get away with it for so long, you know, enough. About it to be successful in this. So I don't know, could be a new leaf for him.
Good luck, Mr. Prick. We wish you nothing but the best. Yes. Don't get sued. I wonder, yeah. Maybe he will get sued. Who knows? you had to violate something. I have to assume, right? If you're, it's one thing, you're right. If it's one thing, if you're a 10 99 contractor, there's still NDAs.
and yeah, you're still working on proprietary kind of backend stuff, it's one thing, being just the front end, practitioner, right? Because medicine, there's not really any, anything proprietary about practicing medicine. A lot of different people practice medicine, different clinics, but Right.
If you're working with kind of the buildup and the proprietary kind of information, I can see how that's a bad thing, maybe. Yeah, it's like the one thing,that maybe that's why engineers make so [00:22:00] much. Who knows. and then just, a quick update. we did a topic about this months back and, we're now, one month out for the telehealth flexibilities, getting ready to expire, and, they're set to expire at the end of September.
Which again, just for everybody's,to remind everybody of what these are, this is the, the COVID flexibility is basically saying that, telemedicine can be provided. Yeah. and so that is set to expire at the end of September. And while there's heavy lobbying, the various associations are, really urging.
Congress to extend and to, make some of those changes. we have yet to have an update there. I am anticipating that there will be an extension. I could not imagine. I wanna say that, I'm gonna knock on wood, you guys can't see me knock, but hopefully you heard it. the [00:23:00] amount of damage that would be caused by.
Winding that down would be, again, extremely detrimental. you, you never know, with kind of like the current political landscape where it's going to land. Yeah. this is actually a pretty big deal. And it's been on everybody's radar. big lobbyist groups, the ATA is pushing hard for it.
just different, Yeah, different conglomerations are Christian for it.we're talking about things like, hey,can you actually see patients everywhere, prior to these extension, you could only, telemedicine's only paid for if you were in rural sites, right?
Or, audio health telehealth. that was a provision that was extended as well. If it reversed back to pre pandemic stuff. Audio only is not gonna get paid. And, some people don't know how or don't even have the technology, another thing is the Ryan Haight Act, controlled substances, behavioral health, medication, that's huge.
It's huge, right? Especially with the physician shortage and access [00:24:00] shortage, that's going to, that's gonna cut into a lot of people's care. So definitely something, especially with this podcast and what we talk about all the time, this is a big deal in tele and something worth paying close attention to.
'cause I think you're right. I think there's enough people that realize that, if we revert back to pre pandemic and take away these provisions, not only businesses but the actual. Provision of care and actually delivery of telehealth,is gonna get affected and a lot of people are gonna lose that care that they've pretty much depended on since, these new processes came along.
September 30th, 2025, I'm expecting something pushed down at September 29th, 2025. I think that's what happened last time, right? Last time. That's what happened last time, right down to the wire. yeah, and again, just to your point, the controlled substance prescribing, extension also is expiring at the end of this year, and that's one that I don't know, and I don't know if it's going to get extended.
they, [00:25:00] they had some, they made some key proposed changes and if that, does go through, there's gonna be a lot of, paperwork and hurdles that. A lot of these telemedicine companies really need to start thinking about,specifically if you are in the mental health space, specifically, if you are in, some of these other areas where you rely on some of that.
similar to like GLP ones, when everybody tried to be shocked when, oh my gosh, like it didn't get, oh my gosh, we can't do compounding. And I warned everybody like, hello, you, you gotta start preparing now for some of these key. changes also because again, how are you going to meet and abide by in-person, visits prior to, prescribing.
Some of those factors are going to make it really difficult for telemedicine. and ultimately if you're a telemedicine doctor working for those platforms that aren't thinking about it, you don't wanna keep working with them if they're ignoring these rules. Yeah. Absolutely. Absolutely. [00:26:00] And again, hopefully advocacy groups like the A TA and a MA are pushing hard to extend this.
And again, I think the overall feeling is yes, it's gonna be extended, but it's definitely coming. it's gonna come down to the wire, right? It always comes down to the wire. So I always say, you prepare. So at the very least, If it gets extended, great. You don't have to do anything, but if it doesn't, you're gonna be screwed.
preparation is key right now, especially just considering the, political climate. Nobody knows. Yeah, that's definitely a dark horse in this, right? yeah. we'll see. We'll see. So rooting for it. Awesome. Cool. Yeah. So that is our August 20, 25, end of month recap. awesome.
Yeah. Kids are back to school, it's gonna get flu season, telemedicine's going to heat up again if it hasn't done so already for y'all. Yeah. I have a sore throat right now. I think I'm getting, I think I'm getting sick. Oh, man. it's blowing up on the platforms, right? Everybody's getting sick.
Yeah. And then they're wondering why [00:27:00] it's, 'cause the Petri dishes are back, Back in school and playing with each other and passing things along and bringing it at home. I didn't think about that. I did not even, yeah. My kids in school For a whole two weeks and I'm already freaking sick. Oh, absolutely.
No, we've already gotten a week and a half. We've gotten two strep notices in one lice notice. It's awesome. Oh no. Gosh. Yeah, this is what we get in schools in Hawaii here . no. Awesome. Thank you. hey, thank you for joining in our, month end recap. Looking forward to updating y'all on the extensions early next month and yeah, come on back.
we got a list of great, great, guests coming up and, excited to talk more. Thank you Phoebe. And thank you'all for joining and this is telemedicine talks. drop us the line, phoebe@telemedicinedocs.com, leo@telemedicinedocs.com. And if you don't, put it out there and info@telemedicinetalks.com.
We'll see you again next time. Yeah. and if you have a story where you got scammed by somebody as a doctor, [00:28:00] I wanna hear it. I wanna hear the funny yes, the funny stuff that these scammers have said to doctors. I find it really comical. And speaking of that, also, if you wanna be on the show owners, Hey, you just wanna just hang out and kick it with us and talk telemedicine stuff for really anything.
just drop us a line. Drop us a line. We'd love to have you on. Folks, see you again next time.