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CIA here to help as Home Health Oversight Ramps Up with Increased Risks

Home Care Nurse

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When a public health emergency was declared last March, the Centers for Medicare & Medicaid Services (CMS) issued a variety of waivers allowing home health providers to more easily provide telehealth services during the crisis.

Now, the Office of Inspector General (OIG) has announced an audit, dubbed the “HHA Telehealth Project,” that will examine home health providers’ usage of telehealth over the last year while the flexibilities were granted. 

The audit will take aim at evaluating the home health services provided by deciphering whether agencies administered and billed for services in an appropriate manner.

“Telehealth has its issues where I think the OIG sees potential areas for fraud,” Matthew Shatzkes, a partner at the law firm Sheppard Mullin, told Home Health Care News. “As a result of the pandemic, there was this mad scramble to be able to shift from your in-person type of services to another modality in telehealth. I think as a result of that, those increased flexibilities could potentially lead to areas of non-compliance.”

The OIG’s mission is to provide objective oversight of the U.S. Department of Health and Human Services (HHS) programs. The watchdog group uses risk analysis and vulnerability-assessment tools to develop its work plans.

Its original plan for the telehealth audit in home health was released in January, but it was revised last week. The final report is expected to come out in 2022.

The goal of these OIG reports is to prevent, detect and deter chances for fraud, waste and abuse. The office will report any services that were inappropriately billed, then make recommendations to CMS based on the results of the project. 

“In the past, in other audits done by governmental agencies, we’ve seen them send out initial request letters for samplings of records, and then go from there,” Shatzkes said. “It’ll be interesting to see how many types of providers will receive the audit request — the sample size that will be requested — and ultimately what the OIG does with it.”

Among the Section 1135 Waiver provisions that were issued were the ability for physical therapists, occupational therapists, speech language pathologists and other non-physician practitioners to open telehealth cases.

CMS also made adjustments that allowed home health agencies to use telehealth alongside in-person services, as long as the technology usage was related to the services being provided and that a description was included on how it would supplement the plan of care.

It’s still unclear how exactly the OIG will go about picking providers to audit. But the OIG’s bandwidth is unlikely great enough to survey a large number of agencies, meaning it will likely choose a smaller sample size.

Despite self-governing efforts to weed out bad actors over the past 10 years, home health care has been ripe with fraud in the past, critics point out. But that’s not the only reason telehealth in the sector would be of interest to the OIG.

Telehealth has been used an unprecedented amount during the public health emergency — and in unprecedented ways.

Before COVID-19, only 11% of patients in the U.S. were using telehealth. But in 2020, 46% of patients were using telehealth in lieu of traditional health care visits, according to a survey by McKinsey & Company.

If this will be the way of the future, it makes sense that the OIG would want to explore the ways in which it’s being used — and if it’s being used appropriately with Medicare dollars.

“I think on some level, it’s an exploratory mission, just to get a sense,” Shatzkes said. “At the same time, I think there’s just a general concern about increased flexibilities and people trying to take advantage of those. Sometimes that’s not even for any sort of nefarious purpose, but one bad apple does spoil the bunch.”

The audit doesn’t necessarily represent all bad news for providers, either.

There’s debate — on both a state and federal level — as to whether these flexibilities should remain after the public health emergency. The OIG project could suggest that there is serious consideration being made to increasing telehealth reimbursement support for home health moving forward.

“I do think on some level that the audit may also be sort of looking at how [everything] was utilized,” Shatzkes said. “Because they have to make a determination as to whether or not those flexibilities should remain in place beyond the public health emergency period.”

And it’s not just home health. It’s likely that these types of audits will continue in health care at large as the pandemic subsides and flexibilities elsewhere are set to expire. 

Yes, to avoid being targeted by the OIG, agencies should avoid committing fraud.

But it’s not that simple. Providers are right to still be concerned over whether all of their ducks are in a row. The first step is making sure documentation is organized and fulfilled.

“I really think documentation is key,” Shatzkes said. “It’s about making sure that your records and your services that were previously rendered are as buttoned up as possible.”

For the agencies that haven’t done so thus far, it could potentially be an issue if the OIG came after them

“If it’s not figured out, obviously there’s limitations in being able to remedy that,” Shatzkes added. “But certainly going forward, providers should make sure that there’s proper documentation of services provided.”

While the probability of being targeted is low, it always helps to have documentation and billing up to speed anyway.

Plus, if the home health sector shows well in the audit — or at least okay — it could show the federal government that the industry deserves more flexibilities related to telehealth in the future.

Additionally, it’s important to note that the telehealth audit isn’t OIG’s only active project related to home health care.

In January, for example, the watchdog announced a review titled “Home Health Agencies’ Challenges and Strategies in Responding to the COVID-19 Pandemic.” In September, it began a review of infection control at home health agencies during the crisis.

OIG has also been analyzing new rural add-on payment methodology since July.

Original article

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