Telehealth Under the Microscope: OIG’s Review Recommends Increased Oversight

Much has been written about the substantial increase in the utilization of telehealth services during the COVID-19 Public Health Emergency (“PHE”), including the 28 million Medicare beneficiaries who received telehealth services during the first year of the pandemic, but a new report from the Department of Health and Human Services, Office of Inspector General (“OIG”) provides a sobering retrospective on the significant program integrity risks associated with the rapid expansion of telehealth.

In an effort to quickly expand access to healthcare services during the initial stages of the PHE, CMS and HHS loosened a number of regulatory restrictions for telehealth providers, including temporarily pausing program integrity activities such as medical review of Medicare claims. While telehealth utilization rapidly increased during the first year of the PHE, these relaxed regulations also contributed to a dramatic rise in aberrant billing practices. The OIG’s review of Medicare and Medicare Advantage encounter data during the first year of the PHE (March 1, 2020, to February 28, 2021) identified a group of 1,714 telehealth providers whose billing practices posed a “high risk” to the Medicare program. The OIG’s review specifically noted the following:

  • These providers were found to have concerning billing on at least one of seven measures indicating fraud, waste, or abuse of telehealth services (e.g., the provider was billing for telehealth services that were not medically necessary, the telehealth services were never provided, etc.).
  • The providers in question received a total of $127.7 million in Medicare fee-for-service payments associated with telehealth services for approximately 500,000 Medicare beneficiaries.
  • Over half of the identified providers (991 of 1,714) were part of a medical practice with at least one other provider whose billing practices posed a risk to the Medicare program, which potentially indicates that these concerning practices were encouraged among these groups of providers.
  • More than 670 of the identified providers inappropriately billed for both a facility fee and a telehealth service for more than 75% of their telehealth visits (approximately 148,000 visits). This represented a total of more than $14.3 million in Medicare payments for facility fees and telehealth services.
  • Many of these providers inappropriately billed for telehealth services at the highest, most expensive level.
  • Some providers repeatedly billed Medicare fee-for-service and a Medicare Advantage plan for the same telehealth service.

Despite concluding that only a small portion of telehealth providers were involved in these high-risk billing practices (for context, approximately 742,000 providers billed for a telehealth service during the first year of the PHE), the OIG’s report stresses the need for increased targeted oversight of telehealth service and improved provider education concerning appropriate billing practices for these services. While CMS has since announced its intention to follow-up with the providers identified in the OIG’s report, it remains to be seen if CMS will implement the OIG’s recommendations or take any additional action with respect to the provision of telehealth services to Medicare beneficiaries.

A link to the full OIG report can be found here.