On April 5, 2018, the Office of the Inspector General (OIG) announced its findings that the Centers for Medicare and Medicaid Services (CMS) paid practitioners for telehealth services that did not meet Medicare requirements. Certain telehealth services are reimbursable by Medicare as Part B services. According to the OIG, it engaged in a review of telehealth services after finding that Medicare paid a total of $17.6 million in telehealth payments in 2015, compared to just $61,302 in 2001.
According to the full report, the OIG concluded that telehealth service requirements were not met in 31 out of 100 surveyed claims. The OIG identified a number of areas of non-compliance, which included:
- Claims were submitted for uncovered services;
- Beneficiaries received services at non-rural originating sites;
- Services were billed by ineligible institutional providers;
- Services were provided to beneficiaries at unauthorized originating sites;
- Improper means of communication were used to provide the services; and
- Services were provided by a physician located outside the United States.
The OIG also found fault with CMS’s telehealth claims review process. According to the OIG’s report, CMS did not: (1) provide proper oversight for payments where telehealth claim edits could not be implemented into CMS’s payment processing systems, (2) ensure that all Medicare contractors’ claim edits were installed in their payment processing systems, and (3) sufficiently make practitioners aware of Medicare telehealth requirements.
Moving forward, the OIG recommended that CMS conduct periodic post-payment reviews to disallow payments for errors, work with Medicare contractors to implement all telehealth claim edits listed in the Medicare Claims Processing Manual, and offer to practitioners additional education and training sessions on Medicare’s telehealth requirements, as well as additional supplemental resources.
The OIG’s review of telehealth services is a reminder to practitioners that the OIG is likely to pay increased attention to practitioners’ compliance with Medicare’s telehealth requirements as the Medicare payments for such services continues to rise.
As the OIG has emphasized, Advisory Opinions are issued only to the requestors of the opinion, and have no application to, and cannot be relied upon by, any individual or entity, nor may they be introduced into evidence by anyone other than the requestors to prove the individual or entity did not violate the anti-kickback statute, or any other law.
This post was co-authored by Chelsea Sousa, legal intern at Robinson+Cole. Chelsea is not yet admitted to practice law.