On March 17, 2020, the Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) issued a Policy Statement addressing the ability of physicians and other practitioners to reduce or waive patient cost-sharing amounts for telehealth services during the 2019 novel coronavirus (COVID-19) outbreak.

This statement of OIG enforcement policy is aimed at giving providers flexibility to offer telehealth services as a way of ensuring patients receive needed healthcare services in a safe and efficient manner throughout the current public health crisis.

OIG Policy Statement

Absent demonstrable financial hardship for a patient, the federal Anti-Kickback Statute and Civil Monetary Penalties Law generally prohibit healthcare providers from routinely waiving or reducing cost-sharing amounts, such as coinsurance and deductibles, owed by federal healthcare program beneficiaries. The OIG, however, recognizes in the Policy Statement that healthcare providers need additional regulatory flexibility to adequately respond to COVID-19 concerns.

Allowing all federal healthcare program beneficiaries to receive medical services through telehealth rather than physically going to a physician’s office protects the health of patients and physician staff by following the self-isolation recommendations to reduce potential exposure to COVID-19. For this reason, the OIG has determined it will not subject physicians and other practitioners to administrative sanctions for waiving patient cost-sharing obligations – irrespective of whether the patient meets financial hardship criteria – if both of the following conditions are met:

  1. A physician or other practitioner reduces or waives cost-sharing obligations, such as coinsurance and deductibles, which a beneficiary may owe for telehealth services furnished consistent with then-applicable coverage and payment rules.
  2. The telehealth services are furnished during the time period subject to the COVID-19 declaration of emergency declared by the HHS Secretary on January 31, 2020.

The Policy Statement does not require healthcare providers to reduce or waive cost-sharing obligations during this time period but gives flexibility to healthcare providers to do so as a means of promoting access to essential telehealth services. Providers also must continue to follow the rules and regulations promulgated by the Centers for Medicare & Medicaid Services (CMS) and other applicable legal authorities, including the responsibility to only bill for services performed and in compliance with proper billing and claims submission requirements.

Impact on Physicians and Other Practitioners

Physicians and other practitioners now have the flexibility under this Policy Statement to waive patient cost-sharing responsibilities during the COVID-19 pandemic without fear of an administrative enforcement action being brought by OIG under the Anti-Kickback Statute or Civil Monetary Penalties Law. These providers, however, should recognize that this flexibility is limited; only applies to telehealth services; and, per the terms of the Policy Statement, may be reconsidered, modified, or terminated by OIG at any time.

Additionally, providers should remain cognizant of the timing of the declaration of emergency and immediately cease any cost-sharing waivers after the emergency declaration is lifted. Finally, providers should continue to follow all CMS and other billing requirements to avoid liability under other laws.

Please reach out to the authors of this alert with any questions related to the Policy Statement and its impact on your operations.