HHS Plans Audit of Medicaid Telehealth Spending

“Audit” is a word that doesn’t exactly inspire happiness or excitement in most people, so it’s likely that a piece of recent news from the Office of the Inspector General (OIG) at the Department of Health and Human Services (HHS) won’t necessarily be a welcome one. As Health Care Law Today and others first reported, the department is planning an audit of Centers for Medicare and Medicaid Services (CMS) payments for state Medicaid telehealth services. The audit is part of the agency’s 2017 work plan. “Accordingly, providers who bill state Medicaid programs for telemedicine, telehealth, or remote patient monitoring services may expect to have those claims reviewed to confirm payment was correctly made in accordance with the conditions for coverage,” health law attorney Nathaniel Lacktman of Foley & Lardner, who specializes in telehealth, wrote on the blog.

Per Lacktman, a report on the audit will likely be issued in 2019, which he notes “is understandable given the sweeping scope of the project and the significant variances in coverage rules across different state Medicaid programs.” He also emphasizes that providers shouldn’t necessarily be worried about the audit or its implications for them and their programs. “Telemedicine providers ought not fear the new OIG project, or see it as a reason not to offer telehealth services to their patients,” he notes, adding that it could ultimately have positive results, particularly as more and more providers opt to use telehealth technologies: “The project and its eventual report can help shed light on those areas of compliance which the OIG believes important,” he adds. While they await more information, however, Lacktman encourages “providers [to] continue to ensure their telehealth programs and claims comply with state Medicaid requirements, including coverage, coding, and documentation rules.”

Earlier this year, as we reported at the time, OIG announced that it would be probing potential improper CMS payments to hospitals for the meaningful use of electronic health records (EHRs) and for telehealth services, amid concerns that the agency may have wrongfully paid out more than $729 million between 2011 and 2016. “These overpayments resulted from inaccuracies in the hospitals’ calculations of total incentive payments,” OIG officials said in a statement at the time that the audit was announced. “We will review the hospitals’ incentive payment calculations to identify potential overpayments that the hospitals would have received as a result of the inaccuracies.” That review is ongoing, with a report expected in 2018.

Click here to read the Health Care Law Today article on the planned OIG audit.


Leave a Reply