Federal Health Care Investigators to Audit Medicaid Telehealth in Behavioral Health in 2019, 2020

Several months ago, the Department of Health and Human Services’ Office of Inspector General (“OIG”) announced its plans, beginning in 2020, to examine how state Medicaid managed care organizations (“MCOs”) provide behavioral health services via telehealth. The OIG announced that it will review “monitoring and oversight” of telehealth services as well as state and MCO practices, for the purpose of understanding how to “maximize the benefits and minimize the risks” of behavioral services via telehealth. The OIG said it will focus its review on “selected” state MCO programs but has not yet announced any individual states. Medicaid MCO reimbursement requirements can vary from state to state and generally can be less restrictive than requirements for Medicare telehealth services. This new OIG audit of Medicaid MCO telehealth comes on the heels of a 2018 OIG audit of Medicare telehealth services, which found that more than half of telehealth claims reviewed by auditors did not meet Medicare documentation requirements. This new audit is expected to conclude sometime in 2020. To view the OIG’s audit announcement information, please click here:

If you have any questions or would like to discuss telehealth issues for your organization, please contact Heather Skelton orEthan Dunn.