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As a provider of OIG healthcare screening for clients around the country, we seek to use this blog to help demonstrate the importance of having an informed background check partner. When you have a partner like ESS who can provide insight into the ever-evolving landscape of healthcare exclusion compliance, you can rest assured that you won’t face any penalties or damage to your organization’s reputation. 

The pandemic was an enormous shift in healthcare. One major component of the shift was the drastic increase in the use of telehealth. Telehealth can be an outstanding new addition to healthcare as technology has evolved to allow medical professionals to monitor and communicate with patients remotely, which could provide a lot of good to the medical community. The catch is, how will the medical community adjust to billing regarding telehealth? How will telehealth affect OIG/HHS compliance?

Let’s take a look at a recent study conducted by the Office of Inspector General.

Why the Study?

Telehealth increased drastically during and after the pandemic. According to the report, medicare beneficiaries used 88x more telehealth services during the first year of the pandemic than they did in the prior year. The drastic increase is cause for concern when considering the federal monitoring of proper medicare billing practices, observing whether providers are billing for telehealth services adequately or not, and how to best protect Medicare and beneficiaries against fraud, waste, and abuse. 

Due to the pandemic, the HHS also temporarily paused several program integrity activities, including reviews of medical claims.

What they Found.

Out of 742,000 providers that billed for a telehealth service, the OIG identified 1714 providers whose billing posed a “high risk,” meaning they’ve been billing for telehealth services that were not medically necessary, OR, were never really provided.

99.98% of healthcare providers showed no evidence of concerning billing practices, but one OIG spokesperson still felt what they found was “extremely concerning.” The research found that over half of the “high-risk” providers were part of a medical practice with at least one other “high-risk” provider. This could mean there are small pockets of groups who may be advocating or encouraging these dark billing tactics.

What’s it Mean?

If you are in the medical field, you’ve probably heard of OIG exclusion. The OIG HHS requires anyone who’s broken legalities in the medical industry to be put on “exclusion lists” that should prevent them from being hired, or working in a medical facility. Having an individual or multiple individuals who are “excluded” and being caught can get you in big trouble, and cause big fines. The introduction of telehealth, coupled with the loosening of some restrictions due to the pandemic, and this OIG study,  mean there are bad actors out there who may be taking advantage of what was meant to be good. Telehealth and the loosening of restrictions were not meant to scrape more money off the top of a medical patient. 

The OIG HHS is taking a big first step toward identifying who hasn’t been following the rules and will surely adopt new policies and legislation that better identifies a more permanent solution for telehealth and medicare billing. It’s important to have a partner who truly understands the OIG HHS world, to help you ensure everyone in your medical organization is in compliance. If you have any questions about your current background check program or any questions about healthcare exclusion searches, please don’t hesitate to reach out! We are more than willing to help!
Here’s a PDF from the OIG