ARTICLE
16 October 2019

OIG To Audit Provision Of Behavioral Health Services Through Tele-Health Under Medicaid Managed Care

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Sheppard Mullin Richter & Hampton

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Sheppard Mullin is a full service Global 100 firm with over 1,000 attorneys in 16 offices located in the United States, Europe and Asia. Since 1927, companies have turned to Sheppard Mullin to handle corporate and technology matters, high stakes litigation and complex financial transactions. In the US, the firm’s clients include more than half of the Fortune 100.
In its recently updated Work Plan, the Office of the Inspector General ("OIG") at the Department of Health & Human Services (HHS) announced that it will conduct ...
United States Food, Drugs, Healthcare, Life Sciences

In its recently updated Work Plan, the Office of the Inspector General ("OIG") at the Department of Health & Human Services (HHS) announced that it will conduct an audit focusing on how selected state Medicaid agencies and Medicaid managed care organizations ("MCOs") leverage telehealth to provide behavioral healthcare.

The OIG's Work Plan assesses relative risks in HHS programs and operations to identify those areas most in need of attention. As part of its telehealth review, OIG will review selected states' monitoring and oversight of MCOs' behavioral health services provided via telehealth. It will also identify states' and MCOs' practices in relation to how to maximize the benefits and minimize the risks of providing behavioral healthcare to Medicaid beneficiaries via telehealth.

OIG expects to issue the report in Fiscal Year 2020. Accordingly, Medicaid managed care plans that reimburse for telehealth services may expect to have those claims reviewed to confirm the patient was at an eligible originating site and that the statutory conditions for coverage were met, among other requirements.

It is unclear whether OIG's decision to audit use of telehealth services for the provision of behavioral health care in the context of Medicaid managed care suggests that OIG will be scrutinizing use of telehealth more generally and in the context of other payers. We will continue to monitor the OIG's activities in this regard and will post blog updates to keep our clients informed.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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