Telehealth is one of the fastest growing markets in health care, and with the ever-increasing availability and growth of technology, telehealth will continue to play a significant role in the future of health care. In an attempt to keep up with the dynamic and rapidly changing telehealth market, federal and state agencies have responded by developing a patchwork of different laws and policies that are largely reactive, rather than systematic. As a result, compliance with the rules and regulations relating to billing for telehealth services has become complex and often times confusing.

For health care providers unfamiliar with the U.S. Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”), the OIG’s mission is to protect the integrity of HHS programs and the health and welfare of the people served by those programs through audits, investigations, and evaluations, as well as outreach, compliance, and educational activities. To this end, the OIG develops a work plan, which prioritizes the OIG’s projects for the upcoming year. These workplans often include audits and evaluations of specific areas and issues the OIG is concerned about.

In October of 2017, the OIG added the review of Medicare payments for telehealth services to its workplan. In November, the OIG reemphasized its recent interest in the telehealth market when it announced that Medicaid telehealth services would also be added to the work plan. For Medicare, it appears that the focus of the OIG’s review will be on Medicare claims paid for by telehealth services provided at distant sites that do not have corresponding claims from originating sites. The goal is to determine whether those services were legitimate and met all of Medicare’s requirements. On the Medicaid side, the OIG signaled that due to the rise in claims for telehealth services, it would select certain states where it will review payments made by Medicaid to providers for the delivery of telehealth services to determine if the payments are permitted and in accordance with that state’s Medicaid rules. At this time, it is unknown which state Medicaid programs will be selected.

With telehealth services continually evolving and expanding, health care providers engaged in delivering and billing for telehealth services to Medicare and Medicaid patients must make sure they are in compliance with all federal and state laws, regulations, and rules because it is only a matter of time before the OIG comes knocking on your “digital” or literal door.

 

Matthew Ullrich’s practice focuses on health care law, specifically related to contract drafting and review, federal and state compliance of Medicaid and Medicare rules and regulations. He also specializes in HIPAA and telehealth matters. He may be reached at 303-443-8010 or mullrich@celaw.com.