OIG issues policy statement and fact sheet on COVID-19 telehealth cost sharing waivers

On Tuesday, March 17, 2020, the Office of Inspector General (OIG) issued a policy statement and related fact sheet stating that providers will not be subject to administrative sanctions for waiving cost-sharing (deductibles or coinsurance) obligations for telehealth services during this public health crisis.  The OIG is imposing two conditions to allow providers to avoid these sanctions: 
  1. The physician or other practitioner waives or reduces the cost sharing obligation that a beneficiary might owe “for telehealth services furnished consistent with the then applicable coverage and payment rules”; and
  2. The telehealth services are furnished during the time period subject to the COVID-19 Declaration.
The OIG issued this policy statement in recognition of the current public health crisis and the associated circumstances surrounding the COVID-19 outbreak.  Ordinarily, the regular waiver of beneficiary cost-sharing obligations would implicate the federal anti-kickback statute, civil monetary penalty and exclusion laws related to kick-backs.  The OIG notes additional considerations in this policy statement:
  • Providers are not required to waive cost sharing obligations;
  • The OIG will not view the provision of free telehealth services, alone, to be an inducement or likely to induce future referrals;
  • The policy statement does not affect the operation of CMS’s programmatic rules and regulations; 
  • Providers are still required to bill for services provided and comply with billing, claims submission, cost-reporting and related legal authorities; and  
  • This policy statement doesn’t affect a provider’s obligation to comply with applicable federal, state and local statutes, rules, regulations, ordinances or other laws in effect at the time the services are provided.  
Please contact the undersigned attorneys for additional information.
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