Phone calling doctorOn March 17, 2020, the Office of Inspector General (“OIG”) issued a Policy Statement that will provide yet another avenue of relief from regulatory requirements as health care providers across the nation deal with the COVID-19 public health emergency.

This specific action by the OIG relieves physicians and other health care practitioners from administrative sanctions if they reduce or waive any cost-sharing obligations from federal health care beneficiaries seeking telehealth services.

Such waivers would normally implicate the federal anti-kickback statute, the civil monetary penalty and exclusion laws related to such kickbacks, and the civil monetary penalty law prohibition on inducement to beneficiaries. OIG’s Policy Statement is not a blanket rule, however. Health care providers must meet both of the following conditions.

First, health care providers who take the action of reducing or waiving a beneficiary’s cost-sharing obligations (such as coinsurance and deductibles) for telehealth services must be furnished consistent with the current applicable coverage and payment rules and, second, the telehealth services must be furnished during the time period of the COVID-19 public health emergency (which was declared on Jan. 27, 2020).

The OIG has outlined five other considerations for health care providers in light of its Policy Statement:

  1. Health care providers are not required to reduce or waive any such cost-sharing obligations.
  2. Should health care providers choose to waive such obligations during this time period, the OIG will not view the furnishing of subsequent services to that beneficiary, without more, as evidence of inducement.
  3. The Policy Statement does not affect any other Centers for Medicare and Medicaid rules and regulations.
  4. Health care providers must still bill only for services performed and comply with other rules with respect to proper billing, claims submission, cost reporting or related conduct.
  5. Health care providers must continue to comply with federal, state or local statutes, rules, regulations, ordinances or other applicable laws.

This action certainly provides additional relief to health care providers who are taking care of patients affected by COVID-19 and who may not have the financial means to seek medical help. Expanding access to telehealth services is likely to relieve the burden of the already crowded emergency rooms across the nation.

For more information, please contact one of the attorneys in our Health Care industry group.

Link to COVID-19 Resources page