OIG to Audit Telehealth Payments to Home Health Care Providers

Health systems and home healthcare agencies who have expanded their telehealth footprint to offer home health services during the coronavirus pandemic may soon be facing federal scrutiny.

The Health and Human Services Department’s Office of the Inspector General has launched an audit of home health services provided through connected health during the COVID-19 public health emergency to verify that providers aren’t doing more than they’re supposed to do to qualify for reimbursement.

The probe targets the confusing and oft-criticized guidelines for Medicare coverage. Providers have long complained that the Centers for Medicare & Medicaid Services offers little telehealth reimbursement, and while CMS has expanded that coverage via section 1135 waivers during the PHE, they don’t match up with the challenges that providers now face in delivering care.

“Telehealth has actually been around for quite a while in home health – a couple of decades at least,” William Dombi, president of the National Association for Home Care & Hospice (NAHC), told mHealthIntelligence in a July 2020 interview. “But it hasn’t worked well from a business sense.”

Home health providers are looking for more latitude from CMS to use telehealth and to bill Medicare for those services. In particular, they’d like CMS to ease up on rules that funnel most reimbursement through the primary care provider, who’s allowed to prescribe and manage telehealth services in the home health space. They’d also like to see more home health providers, including those focused on therapy and rehabilitation services, reimbursed for using telehealth.

Those rules have been relaxed a bit to allow home health providers to use telehealth during the pandemic. Under amended regulations, CMS now allows home healthcare providers to use some telemedicine tools in conjunction with in-person visits, as long as the technology is related to the services provided, it’s included in the plan of care and it doesn’t substitute for an in-person visit.

Now the OIG wants to make sure those guidelines are being followed.

“We will evaluate home health services provided by agencies during the COVID-19 public health emergency to determine which types of skilled services were furnished via telehealth, and whether those services were administered and billed in accordance with Medicare requirements,” the agency said in its notice. “We will report as overpayments any services that were improperly billed (and) will make appropriate recommendations to CMS based on the results of our review.”

The review is expected to be completed next year.