Companies who feel the Public Health Emergency (PHE) waivers and exceptions have rendered telemedicine “immune” from compliance oversight might be surprised to learn what federal regulators have in the works. The Office of Inspector General (OIG) at the Department of Health & Human Services (HHS) is conducting at least seven different national audits, evaluations, and inspections of telemedicine services under the Medicare and Medicaid programs. The audits will also review remote patient monitoring, virtual check-ins, and e-visits. OIG previously issued a report in 2018 on Medicare telehealth billing, using only a small sample size but finding a 31% error rate of claims that did not meet the Medicare requirements for payment for telehealth services. Providers who have begun or increased billing to federal healthcare programs for telehealth services since the inception of the Public Health Emergency should expect those claims to be subject to OIG review.
On February 26, 2021, OIG published a statement on telehealth and fraud concerns, explaining “OIG is conducting significant oversight work assessing telehealth services during the public health emergency.” The goal of these reviews is to ensure “telehealth delivers quality, convenient care for patients and is not compromised by fraud.”
The OIG previously issued a report in 2018 on Medicare telehealth billing, using only a small sample size but finding a 31% error rate of claims that did not meet the Medicare requirements for payment for telehealth services. Providers who have begun or increased billing to federal healthcare programs for telehealth services since the inception of the Public Health Emergency should expect those claims to be subject to OIG review.
OIG Active Work Plan Items
The OIG Work Plan contains dozens of projects affecting Medicare and Medicaid providers, suppliers and payers. The Work Plan reflects (in large part) two aspects of the work of the OIG: 1) Projects originating within the Office of Audit Services (OAS), which conducts financial, billing, and performance audits of HHS programs; and 2) Projects originating within the Office of Evaluations and Inspections (OEI), which provides management reviews and evaluations of HHS program operations. Except by providing general statistics, the Work Plan itself does not detail the work of the Office of Investigations or the Office of Counsel to the Inspector General in investigating and enforcing matters involving specific individual providers and suppliers. In other words, the Work Plan generally reflects a focus on sector performance, rather than that of specific entities, although as noted below the audits may result in the identification of overpayments for specific entities.
The current OIG telemedicine projects are listed and linked below:
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Audit of Home Health Services Provided as Telehealth During the COVID-19 Public Health Emergency. In this report, OIG will evaluate home health services provided by home health agencies (HHAs) during the PHE to determine which types of skilled services were furnished via telehealth, and whether those services were administered and billed in accordance with Medicare requirements. OIG will report as overpayments any services that were improperly billed. The results of this report are expected to be published in 2022.
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Audits of Medicare Part B Telehealth Services During the COVID-19 Public Health Emergency. In this report, OIG will conduct a series of audits of Medicare Part B telehealth services in two phases. Phase one audits will focus on making an early assessment of whether services such as evaluation and management, opioid use disorder, end-stage renal disease, and psychotherapy meet Medicare requirements. Phase two audits will include additional audits of Medicare Part B telehealth services related to distant and originating site locations, virtual check-in services, electronic visits, remote patient…
Read More:OIG Currently Has Seven National Telemedicine Audits
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