OIG Cites Major Flaws in Medicaid Claims for Telemedicine Services in South Carolina
- April 17, 2020
Ninety-six percent of claims for telehealth services paid for by South Carolina’s Medicaid fee-for-service (FFS) program were unallowable because they didn’t meet federal and state requirements, according to a recent report from the Department of Health and Human Services Office of Inspector General (OIG).
OIG audited a sample of 100 Medicaid FFS telemedicine payments in the state between July 2014 and June 2017, finding only three of the payments were allowable. The remaining 97 failed to meet documentation requirements such as recording start and stop times or the consulting site location of the service, which means they shouldn’t have been paid, OIG said.
According to OIG, the high number of faulty payments stemmed from South Carolina’s failure to provide formal training on telemedicine documentation requirements and to monitor compliance.
OIG recommended that South Carolina refund $1.5 million to the federal government and address the lack of formal training and monitoring.
The state agreed with the recommendations to conduct training on telemedicine documentation requirements and enhance monitoring, but argued a lesser refund was appropriate given the type of documentation that was missing. OIG continued to maintain that the state should refund the entire amount of unallowable payments.
The report is 96 Percent of South Carolina's Medicaid Fee-for-Service Telemedicine Payments Were Insufficiently Documented or Otherwise Unallowable (A-04-18-00122 ).