Telehealth Billing Poses Relatively Small Risk to Medicare Program

After reviewing telehealth data from the US Department of Health and Human Services (HHS), the Office of Inspector General (OIG) found that only a small portion of providers whose billing for telehealth posed a high risk to the Medicare program.

As telehealth remains a popular mode of healthcare delivery, efforts surrounding improving and maintaining high-quality services, as well as reducing risks, are ongoing. Telehealth use among Medicare beneficiaries shot up during the pandemic, bolstered by regulatory flexibilities that extended access to the care modality.

To protect against fraud, waste, and abuse, the OIG conducted a study that examined providers’ billing for telehealth services used by Medicare beneficiaries.

On reviewing Medicare fee-for-service claims and Medicare Advantage encounter data, the OIG found that about 28 million (40 percent) Medicare beneficiaries used telehealth during the first year of the pandemic, from March 1, 2020, to Feb. 28, 2021. They also found that approximately 742,000 providers billed for a telehealth service during that time.

Of the 742,000 providers billing for telehealth, 1,714 providers engaged in billing that posed a high risk to Medicare. The high-risk billers received a total of $127.7 million in fee-for-service payments.

Further, researchers developed a list of seven measures that indicate telehealth billing issues related to fraud, waste, and abuse. Of the sample of 1,714 providers, all engaged in billing practices related to at least one of these measures.

More than half of the providers also worked in the same medical practice as at least one other provider whose billing posed a high risk to Medicare, which "may indicate that certain practices are encouraging such billing among their associated providers," according to the report. 

Based on this research, the OIG created a list of recommendations to minimize the billing risk associated with telehealth services provided to Medicare patients.

These suggestions include increasing the oversight of telehealth services, enhancing education on telehealth billing, and identifying telehealth companies that bill Medicare.

Previously, the OIG has engaged in various research efforts to ensure patient safety and combat care issues.

For example, an OIG report from August found that the Veterans Health Administration's digital divide consults and devices process was ineffective and did not use its budget wisely. The OIG made this conclusion based on the limited number of patients that engaged in telehealth appointments and the large number of devices that were left behind following the study's conclusion. They then made recommendations based on findings, which included improvements in communication, increased efforts in device distribution, and the implementation of tracking practices.

Further, the Department of Justice (DOJ) has been cracking down on fraud, waste, and abuse within the telehealth arena.

In July, the DOJ filed criminal charges against 36 defendants in telemedicine-enabled fraud schemes, leading to more than $1.2 billion in losses.