OIG issues guidance on cost-sharing waivers for providers of telehealth services during COVID-19 outbreak

March 25, 2020

Blog Post

On March 24, 2020, the Office of the Inspector General (OIG) released timely guidance to its previous Policy Statement dated March 17, 2020, regarding providers’ ability to reduce or waive cost-sharing expenses for federal health care program beneficiaries, as an exception for telehealth services provided during the coronavirus (COVID-19) outbreak. As explained in a prior alert regarding the OIG’s Policy Statement, under normal circumstances, a provider’s waiver of beneficiary cost-sharing obligations such as co-pays would implicate the federal anti-kickback statute, civil monetary penalty and exclusion laws.

The OIG’s new guidance addresses a number of questions from healthcare providers seeking to clarify the scope of the cost-sharing waiver Policy Statement. The OIG noted that it is “committed to protecting patients by ensuring that healthcare providers have the regulatory flexibility necessary to adequately respond to COVID-19 concerns,” and provided the following information:

The Policy Statement is not limited to the services under 42 C.F.R. § 410.78, referred to by CMS as “telehealth visits.”
The OIG intends for the Policy Statement to apply to a broad category of non-face-to-face services furnished through various modalities:
- Telehealth visits
- Virtual check-in services
- E-visits
- Monthly remote care management
- Monthly remote patient monitoring
The Policy Statement applies to:
- A physician or practitioner (e.g., NPs and PAs) billing for services provided remotely through information or communication technology.
- A hospital or other eligible individual or entity billing on behalf of the physician or practitioner for such services when the physician or practitioner has reassigned his or her rights to receive payments to such individual or entity (e.g., through an employment or contractual relationship).

The OIG stated it will update this guidance upon receiving additional questions related to the Policy Statement. Providers are encouraged to submit questions.

For additional questions regarding telehealth or health care laws, please contact the attorneys below.

Over the past 24 months, the U.S. Department of Health and Human Services Office for Civil Rights has brought notable enforcement efforts against several non-profit covered entities and business associates, resulting in instances of six and seven-figure penalties against providers across the county for incidents involving breaches of protected health information.

A new amendment to New York state law, which would have required all healthcare providers to obtain separate consents from patients for treatment and payment is on hold until further guidance is released, according to the New York Department of Health.

On November 1, 2024, the Centers for Medicare & Medicaid Services issued the Medicare Physician Fee Schedule 2025 final rule, which establishes new advanced primary care management billing codes that will expand opportunities for physician practices, federally qualified health centers, rural health clinics and other health care providers to get paid for services provided by clinical staff under the direction of a physician, nurse practitioner or physician assistant beginning January 1, 2025.

OIG issues guidance on cost-sharing waivers for providers of telehealth services during COVID-19 outbreak

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