Josh Rosaasen , 2025-04-22 14:22:00
Telehealth unlocked new doors and allowed patients to access healthcare with simple clicks but has undergone rapid changes recently. As with the advent of new technologies, new problems arise and virtual “pill mills” stand to be one of the greatest complications as they abuse the loopholes created from telehealth platforms to distribute controlled substances free from comprehensive medical attention.
Not only do these pill mills endanger patient’s lives, but telemedicine’s credibility plummets as well. Stricter rules may pose as a helpful balm, but these ‘solutions’ harm genuine digital healthcare users, such as those managing chronic illness or mental health services in sparsely populated areas. The approaches rendered are: how do we prevent illicit activities without bearing down access to fundamental services?
The rise of ‘pill mills’ in telehealth
During the telehealth era, the operational model changed, along with the definition of a “pill mill”. Now clinics are referred to as “pill mills” whose only requirement is to evaluate patients, regardless if the evaluation is proper, and write a prescription, most commonly for opioids and stimulants. Some online platforms advertise and make their registration so easy that they become the face for questionable prescription practices.
Done Global, a mental health telehealth platform stumbled into controversy in 2023 which resulted in an investigation. They were accused of providing widespread prescriptions of Adderall and other ADHD medications due to their fast-paced consultations which didn’t include proper verification diagnosis and follow up checks. The Department of Justice, as well as the Drug Enforcement Administration, initiated inquiries which uncovered the ease with which digital systems could be abused.
These types of misuse tarnish reputations, but their impact goes beyond that. Other patients reported experiencing clinical withdrawal symptoms as they were forced to rapidly find alternative care solutions during the investigating shutdown. Some participants underwent overtreatment with no means of recovery.
GLP-1 drugs: A new frontier for fraud
Telehealth fraud goes beyond ADHD medication. With the rising demand for Ozempic and Mounjaro, a new variation of fraudulent activity has emerged in the form of counterfeit and black-market versions of prescription medications.
Falsified semaglutide products have been reported circulating in various countries in July 2023, as stated by the World Health Organization. These counterfeits are far more dangerous as they frequently lack the active ingredient, or worse, contain harmful substances.
Why is this the case? Drug scarcity along with exorbitant pricing and patient desperation clearly explain it. In cities such as New York, users have been spotted selling GLP-1 medications for self administration on Facebook Marketplace. In the media, ‘black market Mounjaro’ sales have also been reported within the UK, where patients are purchasing the Mounarjo injections from unscrupulous sites.
This is the realm of the shadow economy, where law-abiding access is restricted, and consumers are unable to differentiate between reliable services and deceptive ones. For consumers, this poses serious health complications – from adverse allergic responses to critical conditions being missed altogether.
Understanding the regulatory landscape
In the face of rampant fraudulent activities, policy enforcers are taking decisive action and increasing penalties. In the case of The Ryan Haight Online Pharmacy Protection Act, first instituted in 2008, at least one in-person assessment for controlled substances prescribing must be done prior to online consultation. However, during the Covid-19 pandemic, some of these restrictions were temporarily eased, making way for more telehealth services.
With temporary waivers about to be canceled, the DEA and HHS have started to reconsider what a flexible but secure option for telemedicine would entail. Suggestions include requiring real-time video consultations, more restrictive documentation requirements, and explicit criteria defining high risk prescribing.
Some states have already passed their own telehealth fraud laws, targeting companies that don’t properly vet providers or that rely on algorithm-based prescribing without human review. Meanwhile, recent enforcement actions by the DOJ, including the high-profile Done Global probe, suggest that regulatory scrutiny is only intensifying.
But the pendulum swings both ways. Tough enforcement risks penalizing compliant providers and cutting off access for at risk populations – especially for those in rural or mobility-limited communities. The goal has to be an equitable approach, separating fraud from frictionless care.
Balancing compliance and access
So how does the industry protect patients without slamming digital doors?
The answer starts with rigorous provider validation. These platforms must perform more than rudimentary credential verification and employ in-depth vetting – verifying licenses, board certifications, malpractice records, etc. Providers who have been verified are the first line of protection against unscrupulous prescribing.
Next, risk-based patient intake procedures can help trigger red flags early. That may be like cross-verifying patient data for “doctor shopping”, the application of AI to identify high-risk drug requests pending manual review temporarily.
Transparency is similarly important. Patients need to be told how the prescribing decisions are being made. Clinical guidelines or marketing figures? Is the site providing after-care of just the prescription? Ethically run sites will have decision-making priorities mirror standards of face-to-face care, not shortcuts.
Critically, telehealth companies should not only be relying on automation. AI can definitely supplement safety, but they must supplement-not-replace-clinical judgement. Real practitioners should screen each prescription, particularly for controlled or high-risk medication.
Looking ahead: Responsible growth in digital health
The future of telehealth is trust. As the market matures, all parties — providers, regulators, and platforms — must collaborate to sustain that trust.
We will see more stringent standards, both federal and state medical boards, and additional industry-led efforts to establish voluntary compliance standards. Solutions such as third-party platforms or certification, public quality ratings, and transparency for prescribers will define the next page in digital care.
Most importantly, patient education will be critical. By helping consumers recognize the difference between genuine services and “too good to be true” pill mills, we can dissuade demand for black-market alternatives and encourage informed decision making.
Photo: Feodora Chiosea, Getty Images
Josh Rosaasen is the Chief Operating Officer at Locke Bio, a digital health platform revolutionizing how branded telehealth services are launched. He has been a driving force behind the company’s rapid growth, expanding its client base, diversifying revenue streams, and enhancing its market-leading platform. Before joining Locke Bio, he led high-impact strategic initiatives within the cannabis industry and advised multibillion-dollar retail clients as a management consultant. A lifelong advocate for healthcare innovation, he has also contributed to published research and spearheaded leadership initiatives with the Canadian Cancer Society.
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