Medicare Compliance & Reimbursement

If you’re a Medicare provider, chances are you received COVID relief money or took advantage of some of the public health emergency (PHE) waivers or flexibilities. And that means your compliance practices may or may not come under scrutiny, especially as federal enforcers continue to vigilantly pursue COVID fraud and abuse.

Add these four key points to your post-PHE watchlist:

1. Testing claims: The HHS Office for Inspector General (OIG) continues to audit COVID-19 testing claims and protocols and currently has 12 active items on its Work Plan. In addition, the Department of Justice (DOJ) continues to bring charges against providers and labs who file false claims, with the latest indictment on March 14.

2. Telehealth claims: Despite the flexibilities under the PHE and the expansion of coverage, telehealth claims submitted during the pandemic remain a sticking point with the feds. OIG lists five separate active items for telehealth services that it’s looking at, including claims for Part B providers, home health agencies, and in Medicaid.

3. COVID funds: CARES Act Provider Relief Fund (PRF) distributions are still being scrutinized by the OIG — there are six Work Plan active items on the topic. Meanwhile, reporting of both PRF distributions and ARP rural payments continues via the HHS Health Resources and Services Administration (HRSA) with Reporting Period (RP)1-3 over, RP 4 currently underway through March 31, and RP 5, 6, and 7 rolling out over the next year.

4. OIG PHE update: The national watchdog reminded providers in a new release that the PHE is ending on May 11 and offered fresh advice on blanket waivers, policy statements on the pandemic, and its past COVID-related FAQs.

Resources: See the OIG Work Plan at https://oig.hhs.gov/ reports-and-publications/workplan/index.asp. Review the OIG PHE update at https://oig.hhs.gov/coronavirus/covid-flex-expiration.asp. See HRSA’s PRF information at www.hrsa.gov/ provider-relief.