OIG to Begin Telehealth Audits

In November 2017, the U.S. Department of Health and Human Services’ (“HHS”) Office of Inspector General (“OIG”) announced that it plans to begin audits of telehealth services that receive Medicaid payments, and such audits have been added to the OIG Work Plan. The purpose of the audits is to ensure that Medicaid payments for services delivered through telecommunication systems comply with Medicaid’s requirements, which is important to stay on top of as the telehealth industry continues to grow and expand. These audits will apply to distant site claims for telehealth services, and not the corresponding claims from the telehealth originating sites.

Current telehealth coverage under Medicaid is fairly limited. Only those telehealth services provided by physicians (and a very few other health care practitioners) to patients at qualifying originating sites are covered. These sites include rural hospitals, physician offices, or critical access hospitals, rural health clinics, federally qualified health centers, hospital-based renal dialysis centers, skilled nursing facilities, or community mental health centers. The fees for these services are fixed, with Medicaid paying the distant site provider based upon a fee schedule, and paying the originating site a telehealth facility fee.

The OIG’s decision to focus on these telehealth audits reflects telehealth’s rising popularity, but also the fact that data from 2016 and 2014 shows that as many as half of all telehealth claims from distant sites did not have corresponding originating site claims. This hints at the possibility that some Medicaid beneficiaries may be making claims for telehealth services that Medicaid is not required to pay for. These audits hope to clear up that issue.  If providers and beneficiaries wish to enjoy the benefits and use of telehealth services, they must comply with Medicaid’s requirements. With the OIG Work Plan slated to begin these audits in 2018, there is no better time than now for telehealth providers to consult an experienced healthcare attorney to ensure their practices are in line with all Medicaid requirements.