WASHINTON, D.C. (September 9, 2022)—More than 1,700 Medicare providers have indications that they fraudulently billed Medicare for telehealth services, according to a new report from the Department of Health and Human Services (HHS) Office of Inspector General (OIG). These providers billed telehealth services for about half a million beneficiaries and received a total of $127.7 million in Medicare fee-for-service payments.
The OIG looked at claims data from 742,000 providers during the first year of the COVID-19 pandemic, from March 1, 2020, to Feb. 28, 2021. HHS and the Centers for Medicare & Medicaid Services (CMS) took action to temporarily expand access to telehealth for Medicare beneficiaries. In addition, CMS temporarily paused several program integrity activities, including medical reviews of claims. A related report found that Medicare beneficiaries dramatically increased their use of telehealth services as a result of these actions.
The changes to Medicare telehealth policies, along with the dramatic increase in the use of telehealth, underscore the importance of determining whether providers are billing for telehealth services appropriately and how to best protect Medicare and beneficiaries against fraud, waste and abuse, the OIG said.
The 1,714 providers found to have billing issues missed the mark on at least one of seven quality measures the OIG has set out to measure fraud, waste and abuse of telehealth services. More than half of the providers belong to a practice where at least one other provider had billing issues, indicating that certain practices are encouraging such billing among their associated providers, said the report. Additionally 41 providers appeared to be telehealth-exclusive providers, but Medicare does not currently have a way to identify those providers.
The problematic providers represent a small proportion of those who billed for telehealth services during the target time period; however, the OIG recommended that HHS and CMS strengthen monitoring and targeted oversight of telehealth services; provide additional education to providers on appropriate billing for telehealth services; improve the transparency of “incident to” services when clinical staff primarily delivered the telehealth service; identify telehealth companies that bill Medicare; and follow up on the providers identified in the report.
The House recently passed a two-year extension of telehealth flexibilities, though the Senate has yet to take up the bill.
