Dive Brief:
- A small but concerning proportion of providers billed Medicare inappropriately for telehealth early in the coronavirus pandemic, according to a new report from the HHS Office of Inspector General.
- Telehealth lobbies including the American Telemedicine Association said the report proves measures enacted to safeguard Medicare against fraud, waste and abuse work well.
- It comes as lawmakers and regulators continue to puzzle over how many pandemic-era telehealth flexibilities should continue after the public health emergency ends. The potential for rampant fraud has been a concern aired by some members of Congress considering permanently expanding access.
Dive Insight:
The government quickly removed barriers to telemedicine visits in the early days of COVID-19, as the pandemic winnowed access to in-person medical care.
As a result, the use of telehealth skyrocketed in the first year of the pandemic. More than 28 million Medicare beneficiaries — roughly two in five — used virtual care in that year. In total, beneficiaries used 88 times more telehealth services in COVID-19’s first year than in the year prior, according to OIG data.
As telehealth use increased dramatically, the HHS also temporarily paused several program integrity activities, including reviews of medical claims. As a result, it’s important to determine whether providers are billing for telehealth services appropriately, the OIG said.
The OIG based its analysis — part of a series on the use of telehealth in Medicare — on Medicare fee-for-service claims data and Medicare Advantage encounter data from March 2020 through February 2021. Regulators focused on the roughly 742,000 providers that billed for a telehealth service, looking for indicators of fraud, waste or abuse, and set a high threshold to identify providers with billing practices that pose a “high risk” to Medicare.
The OIG identified 1,714 providers whose billing posed a high risk, meaning they may have been billing for telehealth services that were not medically necessary or were never provided.
That’s a small proportion of the whole. Telehealth Access for America, a telehealth lobby, noted that means 99.98% of healthcare providers showed no evidence of worrying billing practices, but an OIG spokesperson called the instances they found “extremely concerning.”
High-risk providers billed for telehealth services for roughly half a million Medicare beneficiaries, and received almost $128 million in fee-for-service payments in one year, according to the report.
More than half of these high-risk providers were part of a medical practice with at least one other high-risk provider, which could indicate certain practices are encouraging such billing practices, the OIG said. Just 41 high-risk providers appear to be associated with telehealth companies, though there’s no systematic way to identify these companies in the Medicare data, according to regulators.
The OIG recommended the CMS strengthen monitoring of telehealth services, further educate providers on appropriate billing practices and identify telehealth companies that bill Medicare. It also suggested the CMS follow up on the high-risk providers highlighted in its report.
The CMS agreed with that recommendation.
In a statement on the report, ATA Senior Vice President Kyle Zebley said the organization and its members are “ready to work with the Office of the Inspector General to incorporate appropriate oversights and safeguards to maintain telehealth program integrity.”
The House recently passed a two-year extension of telehealth flexibilities, though the Senate has yet to take up the bill. Meanwhile, physicians are urging the CMS not to decrease payment rates for telehealth services next year, after reimbursing virtual care visits at the same rate as in-office visits during COVID-19.
