OIG Report: Telehealth Services Need Targeted Oversight to Safeguard Medicare

More than 40% of Medicare beneficiaries used telehealth services during the first year of the COVID-19 pandemic.[1] In a recent report, the Office of Inspector General (OIG)  described ways to “best protect Medicare and beneficiaries against fraud, waste, and abuse.”

OIG found 1,714 providers whose telehealth billing practices pose a high risk to Medicare.[2] Those providers billed for telehealth services for about half a million beneficiaries amounting to $127.7 million in Medicare payments. Furthermore, more than half of the high-risk providers were part a medical practice with at least one other provider whose billing also poses a high risk to Medicare. OIG determined this could indicate that certain practices are encouraging this type of billing. Additionally, 41 of the high-risk billing providers appear to be associated with telehealth companies (i.e., companies that employ practitioners to provide on-demand telehealth services to beneficiaries).

OIG concluded that strong, targeted oversight of telehealth services is needed. Specifically, it recommended that CMS:

1. Strengthen monitoring and targeted oversight of telehealth services,
2. Provide additional education to providers about appropriate billing for telehealth services,
3. Improve transparency of “incident to” services when clinical staff primarily delivered the telehealth service,
4. Identify telehealth companies that bill Medicare, and
5. Follow up on the providers identified in the Report.

___________________

[1] OIG. Telehealth was critical for providing services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic. OEI-02-20-00520 03-15-2022. (March 15, 2022).  https://oig.hhs.gov/oei/reports/OEI-02-20-00520.asp 
[2] OIG. Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks. OEI-02-20-00720 09-02-2022. (September 2, 2022). https://oig.hhs.gov/oei/reports/OEI-02-20-00720.asp