Telehealth Restrictions, telehealth services, medicare reimbursement

HHS Gets Sued for Telehealth Medicare Reimbursement Restrictions


September 28, 2021 | Reading Time: 2 Minutes

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For decades, Medicare providers have commonly understood that services to U.S. citizens are required to have their feet firmly planted on American soil at the time of service delivery. This rule also applies to the delivery of telehealth services. According to a report in Healthcare IT News, a Florida-based company,  RemoteICU, has taken exception to this rule.

The company facilitated telemedicine services between overseas specialists and U.S. hospitals prior to being stopped. Now the company has sued HHS over the agency’s telehealth restrictions. Despite waivers implemented under Medicare, RemoteICU has not expanded to new facilities since HHS does not reimburse telemedicine specialists living outside of the United States.

Mr. Jesse Panuccio, a partner at Boies Schiller Flexner and counsel for RemoteICU, believes HHS needs to evolve with technology rather than clinging to a 1960s perspective. According to him, with remote care, patients aren’t affected by a physician’s location. He explains if a patient lives in a small town in Louisiana, and his doctor is in a remote office in New Orleans, the patient sees no difference in whether the doctor is in Tel Aviv or New Orleans. Quality of care needs to be a priority instead of the physician’s location, he adds.

Details about RemoteICU’s Lawsuit Concerning Telehealth Medicare Restrictions

RemoteICU’s team consists of several dozens of board-certified, U.S. licensed intensivists who have been trained in the United States and have practice experience. Despite living abroad, the physicians work full-time as permanent staff members of the hospitals caring for patients. By hiring professionals from other countries, RemoteICU can easily provide care throughout the day as well as cover night shifts.

The lawsuit was first filed by RemoteICU in February of 2021 in the U.S. district court for the District of Columbia. According to court records, RemoteICU contacted authorities from the Department of HHS and the Centers for Medicare and Medicaid Services after the agencies eased telehealth restrictions and requirements under COVID-19. After months of debate, the agency concluded that Medicare reimbursement would not be made available to the RemoteICU hospital clients. The district court approved HHS’ petition to dismiss the lawsuit, ruling that it lacked subject matter jurisdiction to consider the claims. RemoteICU appealed and recently filed a motion for an accelerated hearing, claiming that the pandemic had made the issue more critical.

Many U.S. licensed providers live outside the United States, both temporarily or permanently. Under the current ruling, companies such as RemoteICU to the individual practitioner cannot serve a patient. If a U.S. licensed provider travels abroad and can serve a patient through telehealth they are prohibited from claiming reimbursement for Medicare beneficiaries. This lawsuit is of potential interest to telehealth Medicare providers are following the rapidly expanding reimbursement opportunities for telehealth through Medicare. 

Telehealth Medicare Reimbursement Restrictions

This case also highlights the need for Medicare providers who offer telehealth Medicare services to know about the geographic restrictions currently imposed on all providers. Again, your feet must be on US soil to bill for Medicare. If you bill fraudulently, sanctions can be harsh. Your opinion is invited below to discuss Medicare’s recently defended stance of restricting telehealth practice by legitimate, licensed telehealth Medicare providers if they are aboard at the time of service delivery.

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1 year ago

This will be very interesting to observe. Thanks for the information.

Emanuelle 'Em' Gomez
Emanuelle 'Em' Gomez
1 year ago

My biggest concern is whether Medicare and other insurance companies will continue to pay for telehealth once the ’emergency’ status is lifted which is supposed to be later this month. I’ve been told Medicare will stop and other insurance companies will follow. I’m a psychotherapist, LCSW. Em

viorica lazin
viorica lazin
1 year ago

Thank you Dr. Maheu for all the diligence and hard work you do to promote telehealth.
I am looking forward to seeing if the Medicare Dinoasurus changes its obsolete approaches.

Michelle Rondeau
Michelle Rondeau
1 year ago

I am a nurse, a Canadian, and I worked in the United States for 28 years and I lived there for six of those years. I live in a border city in Canada. I have Medicare, and I have some doctors in the United States but I am not able to cross the border due to COVID restrictions. I would, therefore love to be able to have appointments with my doctors in the US via A-V Technology. I don’t think it should matter whether the practitioner’s feet or the patient’s feet are firmly planted on US soil but I am interested to learn the rationale of those who are opposed.

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