Teladoc has filed an antitrust lawsuit against the Texas Medical Board, charging that the board is "illegally limiting competition" in enacting new guidelines that mandate an in-person visit before certain telehealth encounters.

The suit, filed April 29 in U.S. District Court in Austin, continues a four-year battle between the Dallas-based telehealth provider and state medical officials who feel a patient and doctor should first meet face-to-face before the doctor can prescribe medications. The board recently revised its rules to mandate such a visit, with the revision scheduled to take effect June 1.

[See also: Texas board curbs telemedicine, prompts lawsuit]

Teladoc, which launched in 2002 and bills itself as the nation's first and largest telehealth company, conducts roughly 70 percent of its business via telephone. It reportedly serves more than 2.4 million Texans.

“It is clear that the medical board acted only when Teladoc consultations became sufficiently numerous to be perceived as a competitive threat to brick-and-mortar physician practices,” Jason Gorevic, Teladoc’s chief executive officer, said in a press release announcing the lawsuit. “We can’t sit back and let a bad rule by the Texas Medical Board rob from millions of consumers and physicians the tremendous benefits of telehealth. California, Colorado, North Carolina, Kentucky, Virginia and dozens of other states have found solutions that embrace telehealth, and all of its benefits, while ensuring patient safety.”

"The medical board asserts that the new rule is to address concerns about patient safety,” he added. “But not one shred of data was presented during the medical board’s comment period to support the position that telehealth poses a patient safety risk.”

[See also: Is a phone call good enough for telehealth?]

The lawsuit claims that the board’s rule violates the Sherman Antitrust Act, "which has protected free-market business innovations from cartels and monopolies for more than 100 years." Teladoc officials say the rule could have "severe financial consequences for telehealth companies as well as patients," and argue that Texas physicians have treated patients for decades by phone and other means.

In an interview with mHealth News earlier this year, Gorevic noted that Teladoc's telephone-based consults aren't conducted in a vacuum. Physicians access medical records and other resources before or during the conversation, he said, so that they're looking at a complete medical history of their patient.

Following its contentious ruling earlier this month, the Texas Medical Board didn't just sit silent. It unveiled a news release – a rarity for the organization – announcing "TMB Adopts Rules Expanding Telemedicine Opportunities."

"Essentially the only scenario prohibited in Texas is one in which a physician treats an unknown patient using telemedicine, without any objective diagnostic data, and no ability to follow up with the patient," the releases stated.

The release outlined three types of telemedicine authorized by the board:

1. Patients can interact with physicians via telemedicine beyond the traditional office visit;
2. Once a diagnosis is made via a face-to-face visit (either in person or via telemedicine), the physician can treat that patient for up to a year in the patient's home for that pre-existing condition via telemedicine;
3. Mental health services can be provided via telemedicine, either at the patient's home or in a group or institutional setting.

In addition, the board emphasized that its ruling doesn't limit the patient to an in-person initial visit – that first visit could be done via face-to-face telemedicine. The board also argued that its ruling doesn't hinder traditional on-call coverage and it doesn't "severely restrict the types of telemedicine scenarios authorized in Texas."

"The rules expand the scenarios already allowed to include greater access to treatment from a patient’s home and greater access to treatment for behavioral and mental health," the release concluded.

Teladoc isn't the only organization at odds with the Texas Medical Board's ruling. The Texas Medical Association, a private, non-profit association of Texas physicians and medical students that was founded in 1853, offered up a four-page letter to the board that indicated the ruling would disrupt cross-coverage services. Another group, Help Access Telemedicine for Texans (HATT), was harsher in its criticism.

"Despite the fact that Texas’ two largest telemedicine providers serve nearly 3 million Texas lives (and those providers have served Texans without a single malpractice claim for close to a decade), TMB chose to eliminate the benefits of those telemedicine services, despite warnings that their rule would limit access to healthcare, and eliminate a valuable cost containment tool upon which millions of Texans and their employers rely to keep healthcare costs in check," HATT Director Josh Meeks argued.

[See also: Patients: telehealth tops the doctor's office]