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OIG: Providers Should Prepare for New CMS Telehealth 'Guardrails' and a 'Cleanup on Back End'

Troubled by some of the telehealth practices it’s observing, the HHS Office of Inspector General (OIG) “is providing information about fraud we have identified” to CMS that will be useful as it establishes “guardrails” and standards to protect Medicare and Medicaid now that the doors are wide open to telehealth during the COVID-19 public health emergency (PHE) and possibly beyond, an OIG official says. There may be a lot of noncompliance to pursue, which is OIG’s territory.

“The scope here is unbelievable,” said Michael Cohen, OIG’s headquarters operations officer. “And we are finding new vulnerabilities we would never have anticipated.”

The new standards, which could include national coverage determinations, will help providers avoid conduct that runs afoul of fraud and abuse laws. “CMS is looking at doing [telehealth] permanently, so we have to put in guardrails and standards if we do it long term,” Cohen told RMC. Medicare watchdogs are trying to find a balance between “legitimate care” and fraud prevention. “Not everything can be done over the internet,” said Cohen, an attorney and physician assistant.

At the same time, providers should brace for “years of cleanup on the back end” after the PHE ends, he said. “Normal billing edits were removed during the PHE because the last thing we want to do is prevent medical care during a pandemic.”

Cohen wants to make something crystal clear: OIG “is in favor of telehealth,” he said. “Often we come across as being anti-telehealth, but we really are not.” He cited many ways it’s beneficial. For example, “remote patient monitoring is one of the best things that can happen,” and telehealth has proven valuable for providing mental health care and services in health professional shortage areas. But “whenever you have good ships, there can be rats on the ship, and we are seeing big, nasty rats,” Cohen said. OIG’s concerns are mounting as it watches the pandemic-fueled telehealth freight train gather speed.

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