The incremental adoption of telehealth services exploded at the onset of the COVID-19 public health emergency (PHE), establishing telehealth as an integral tool for patient care.
In efforts to maintain access to health care services and facilitate compliance with public health guidelines designed to slow the spread of COVID-19, regulatory agencies actively encouraged the use of telehealth services and suspended requirements that may impede the use of telehealth to manage the immediate consequences of the PHE.
For example, the U.S. Department of Health and Human Services (HHS) and agencies within the Department issued Section 1135 waivers, guidance regarding agencies’ exercise of enforcement discretion and emergency rulemaking to ease administrative burdens on health care providers and remove regulatory barriers to care during the PHE.
The HHS Office of Inspector General (OIG) and other federal law enforcement agencies, however, have recently redirected their focus to audit and oversee providers’ compliance with telehealth requirements during the PHE.
In September 2020, OIG, along with its state and federal law enforcement partners, participated in a National Health Care Fraud Takedown aimed at telehealth services. The 2020 takedown led to charges against more than 345 defendants—including telemedicine company executives, medical practitioners, marketers, and business owners—related to health care fraud schemes involving more than $6 billion in alleged losses to federal health care programs. As a result, 256 medical professionals had their federal health care program billing privileges revoked.
In 2021, the OIG Work Plan continues the focus on fraudulent telehealth services, including audit items in the Work Plan aimed at: (1) home health services (2) Medicare Part B services, and (3) Behavioral Health Services in Medicaid Managed Care as provided via telehealth during the PHE.
Via these Work Plan additions, OIG makes clear that despite guidance and numerous waivers encouraging the expansion of telehealth services during the PHE, these services remain subject to strict compliance measures.
Providers must remain vigilant to ensure that telehealth claims satisfy all applicable requirements.