Telehealth Summer 2025: Collaboration Models, Enforcement Trends, and Reimbursement Guidance

It has been a busy summer for telehealth updates. Following is a high-level summary of the latest developments.

On June 6, 2025, the Office of Inspector General of the U.S. Department of Health and Human Services (the “OIG”) issued an advisory opinion (25-03), which may provide a model for structuring telehealth collaborations that are compliant with federal and state laws and enable expanded patient access, particularly in rural and underserved communities.  A management services organization and its affiliated physician entity (“PC”) proposed an arrangement with telehealth providers and their management platforms (“Telehealth Co.”) under which the PC would lease the services of Telehealth Co healthcare professionals to provide services to PC’s patients, after being enrolled and credentialed in PC’s payor contracts.  PC had a larger payor base than Telehealth Co, which would allow patients greater access to in-network coverage.  An hourly fee would be charged for clinical and administrative services, which would be independently verified as fair market value compensation, and was not conditioned upon reimbursement by third-party payors.  PC certified that the proposed arrangement otherwise met all of the criteria of the safe harbor for personal services and management contracts.  Although the payment of a fee for referral of patients who received services reimbursable by a Federal health care program potentially implicated the Federal anti-kickback statute, the OIG concluded that the safe harbor criteria were satisfied by the proposed terms.

The Department of Justice announced a record-breaking takedown on June 30, 2025, involving charges against 324 defendants and targeting schemes with over $14.6 billing in intended losses to federal healthcare programs.  This action represented the largest healthcare takedown action in history, involving numerous federal and state law enforcement agencies across the country.  The fraudulent telehealth claims involved deceptive telemarketing campaigns targeting Medicare beneficiaries for genetic testing and durable medical equipment, both of which tend to be ripe areas for fraud investigations.

Upon the effectiveness of the “One Big Beautiful Bill Act” as of July 4, 2025, telehealth safe harbors were permanently extended for high-deductible health plans (“HDHP”) for plan years beginning after December 31, 2024.  These safe harbors expand access to telehealth and other remote care services such that HDHPs may continue these services without cost-sharing or impact to a Health Savings Account.  As a result, telehealth services are covered before meeting a deductible, making services more accessible and affordable.

On July 14, 2025, CMS issued the 2026 proposed Medicare physician fee schedule with important provisions for the telehealth sector.  Comments are being accepted through September 12, 2025.  CMS proposes simplifying its review process for requests to add to the Medicare Telehealth Services List, acknowledging that practitioners are best positioned to determine whether a service should be provided via telehealth for a particular patient.  In particular, CMS proposes removing the requirements to evaluate services for “permanent” or “provisional” status as well as the need to demonstrate that a telehealth service provides the same clinical benefit as in-person care.  Additionally, CMS proposes removing telehealth frequency limits for subsequent inpatient and nursing facility visits, and critical care consultations, removing the requirement for in-person encounters after a certain number of telehealth visits.  In addition to certain other revisions, CMS proposed extending its policy regarding remote supervision via telehealth for applicable incident-to services, diagnostic tests, pulmonary and cardiac rehabilitation services.  This represents another extension of policies first introduced during the Covid pandemic.

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