The opportunity for expanded use of telehealth services spurred by the COVID-19 pandemic provided many individuals with greater access to healthcare services and allowed providers to furnish patient care in safe environments. However, this expansion has led to potential abuse concerns, prompting the Department of Health and Human Services (HHS) Office of Inspector General (OIG) to issue a statement announcing that OIG is conducting seven different audits, evaluations, and inspections of telehealth services under the Medicare and Medicaid programs.
Because OIG is investigating providers specific to telemedicine, these audits will review remote patient monitoring, virtual check-ins, and e-visits. An OIG report issued in April 2018 concluded that 31% of the sample claims reviewed did not meet the Medicare conditions for payment for telehealth services. That report was prior to the broad expansion of telemedicine from the COVID -19 pandemic. Providers who have billed for telehealth services during the public health emergency (PHE) should be prepared to undergo audits of those claims.
Current OIG telemedicine audit projects include:
- Audit of Home Health Services Provided as Telehealth During the COVID-19 PHE
- Audits of Medicare Part B Telehealth Services During the COVID -19 PHE
- Home Health Agencies’ Challenges and Strategies in Responding to the COVID -19 Pandemic
- Medicare Telehealth Services During the COVID -19 Pandemic: Program Integrity Risks
- Use of Medicare Telehealth Services During the COVID -19 Pandemic
- Medicaid: Telehealth Expansion During the COVID -19 Emergency
- Use of Telehealth to Provide Behavioral Health Services in Medicaid Managed Care
The PHE triggered rapid growth in telemedicine, remote patient monitoring, and other virtual care services for many healthcare providers. There are a variety of ways to respond to and defend an OIG audit. Providers should also be aware that guidance and requirements surrounding telehealth services have shifted and evolved over the course of the public health emergency and that many are based on temporary regulatory authority. Lastly, the results of an OIG or Medicare audit can generally be appealed if the provider acts within the applicable timeframe.
For over 35 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters, and our attorneys can assist providers and suppliers in understanding and responding to a telemedicine audit. If you or your healthcare entity has any questions pertaining to healthcare compliance, please contact an experienced healthcare attorney at 248-544-0888 or wapc@wachler.com.