In a recent policy statement, Principal Deputy Inspector General Grimm of the Department of Health and Human Services – Office of Inspector General ("OIG"), highlighted OIG's support for increased telehealth flexibilities over the last year and expressed the potential for expanding coverage based on the experience of providers and patients during the COVID-19 pandemic. Pointing to a 2019 OIG study and recent rulemaking, OIG leadership views telehealth as "an important tool.for improving care coordination and health outcomes," including access to behavioral health services. However, as the national discussion for expanding coverage of telehealth services continues, OIG has also emphasized its commitment to ensuring that any new telehealth policies and technologies are not compromised by fraud, abuse or misuse. Currently, OIG is conducting "significant oversight work" to assess telehealth services provided during the public health emergency. With a goal of providing findings and recommendations to policymakers and other stakeholders to aid decision-making concerning permanent telehealth flexibilities, OIG anticipates publishing its reviews later this year. Meanwhile, OIG will also continue to monitor for "telefraud" which has involved telemarketing schemes by which disreputable doctors fraudulently bill for items or services such as durable medical equipment or lab tests. In addition to pursuing enforcement against such "telefraud" schemes, OIG has also stated that it will begin monitoring for scams relating to telehealth.
While OIG recognizes the many patient care benefits and value associated with telehealth services, Inspector Grimm's comments clearly indicate that OIG will show little tolerance for any telehealth practices involving fraud and abuse, regardless of when the alleged fraud occurred. Other governmental agencies will likely follow OIG's lead and target telehealth for review. Since these reviews could uncover not only fraudulent conduct but honest mistakes, providers should consider adding telehealth to their compliance work plans if they have not already done so. Accordingly, telehealth providers should closely monitor and proactively audit their telehealth coding and billing practices, take all necessary measures to address any noncompliance and consider contacting their compliance counsel for assistance in evaluating next steps.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.