OIG Issues Policy Statement to Reduce/Waive Cost-Sharing Amounts for Telehealth Services during the COVID-19 Outbreak

On March 17, 2020, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a policy statement in response to the 2019 novel coronavirus (COVID-19) outbreak and the HHS Secretary’s determination that a public health emergency has existed nationwide since January 27, 2020 (the “Policy Statement”). The Policy Statement provides that the OIG will not subject physicians and other practitioners to administrative sanctions for reducing or waiving cost-sharing obligations owed by Federal healthcare program beneficiaries for telehealth services if the arrangements meet the two (2) following conditions:

  1. A physician or other practitioner reduces or waives cost-sharing obligations (i.e., coinsurance and deductibles) that a beneficiary may owe for telehealth services furnished consistent with the then-applicable coverage and payment rules.
  2. The telehealth services are furnished during the time period subject to the COVID-19 Declaration.

The applicable time period for the Covid-19 Declaration is January 27, 2020 until either 90-days following the Declaration (i.e., April 26, 2020) or the date in which the HHS Secretary declares the public health emergency no longer exists, whichever occurs first. Note that the HHS Secretary may extend this time period for as long as the public health emergency continues.

Generally, routine reduction or waiver of such cost-sharing obligations would implicate the Federal anti-kickback statute, the civil monetary penalty and exclusion laws related to kickbacks, and the civil monetary penalty law prohibition on inducements to beneficiaries. However, the OIG believes such regulatory flexibility to be necessary at this time to adequately respond to the nation’s COVID-19 outbreak concerns.

Please note that the OIG reserves the right to reconsider the issues raised in the Policy Statement and to modify/terminate the Policy Statement. Lastly, physicians and practitioners are still obligated to adhere to CMS’ programmatic rules and regulations and to otherwise comply with all legal authorities regarding billing.

Contact Adrienne Dresevic, Esq. at (248) 996-8510 for assistance or any questions regarding reducing and/or waiving cost-sharing amounts for telemedicine.