OIG approves telehealth purchasing arrangement that would support HIV care

The Department of Health and Human Services Office of Inspector General (OIG) weighed in on the legality of a telehealth relationship for the fifth time, giving the nod to an equipment sharing scenario to assist with HIV prevention.

In an advisory (PDF) released on Friday, the OIG responded to a request involving a federally qualified health center and a county health clinic in which the hospital would purchase equipment—including a laptop, webcam, microphone and video conferencing software—for a county-run clinic to provide free HIV prevention consultations. Regulators ruled that although the arrangement could potentially induce referrals by providing free telehealth consultations, the OIG would not impose administrative actions under the anti-kickback statute.

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The requesters noted that the hospital is 80 miles from the clinic and the telehealth equipment would give patients access to HIV services, particularly consultations for pre- and post-exposure medications that must be taken within 72 hours after exposure.

The OIG indicated that a number of safeguards included in the partnership, along with the potential community benefits, were factors in the approval.

“Increased access to preventative HIV services could reduce the prevalence of HIV and promote public health,” the OIG wrote.

Nate Lacktman, a partner with Foley Lardner LLP who chairs the firm’s telemedicine industry team, said the advisory aligns with a 2011 opinion in which the OIG allowed a health system to provide community hospitals with free telemedicine technology as part of a telestroke arrangement.

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He added that distance was clearly a factor in weighing the risk of inducing patient referrals, and the fact that the health center’s affiliated pharmacy was 80 miles away from the clinic lowered the risk of patient steering for HIV medications.

“The OIG did note, however, that its analysis could differ if it was a mail-order pharmacy that delivered medications directly to patient’s homes,” he said.

The opinion comes as OIG is keeping a close eye on telehealth payments in both Medicaid and Medicare. In April, the watchdog agency identified $3.7 million in improper Medicare telehealth payments, potentially inviting more scrutiny for providers. Last November, the OIG indicated it plans to audit Medicaid payments in a report scheduled for 2019.

While there’s been broad support for expanding telehealth reimbursement through federal programs, groups like MedPAC have cautioned it could lead to a spike in improper payments.