OIG recommends CMS reinforce telehealth supervision after warnings of insurance fraud

• A recent OIG report stated that 1,714 out of 742,000 providers billed for telehealth services that were not medically necessary or were never provided.  
• These high-risk providers received $127.7 million in fee-for-service payments in a year. 
• The OIG recommended the CMS strengthen monitoring telehealth services, educate providers on billing practices, and contact high-risk providers. 

According to a recent report from the HHS (Department of Health & Human Services) Office of Inspector General (OIG), 1,714 out of 742,000 providers billed for a telehealth service posed a high risk. This means they may have been billing for these services that were not medically necessary or were never provided. 

These high-risk providers billed telehealth services for half a million Medicare beneficiaries and received $127.7 million in fee-for-service payments in one year.  

Even if most providers correctly billed for telehealth services in the first year of the COVID-19 pandemic, the OIG called the instances they found in the report “extremely concerning.”   

Another finding was that over half of the providers whose billing raised suspicion worked in physician practices where at least one other doctor also filed such claims. The OIG stated that this might indicate that certain practices encourage such billing among their associated providers. 

The report is based on Medicare fee-for-service claims data and Medicare Advantage encounter data from March 2020 through February 2021. Regulators focused on looking for indicators of fraud, waste, or abuse. They set a high threshold to identify providers with billing practices that pose a “high risk” to Medicare. 

The OIG recommended the CMS (Centers for Medicare & Medicaid Services) the following:  

• Strengthen monitoring of telehealth services.  
• Educate providers on appropriate telehealth billing practices. 
• Identify telehealth companies that bill Medicare.  
• Contact providers identified as incorrectly billing Medicare in the report to find out why.  

Kyle Zebley, Senior Vice President of the American Telemedicine Association (ATA), said in a statement that the organization and its members are “ready to work with the OIG to incorporate appropriate oversights and safeguards to maintain telehealth program integrity.”   

Read more about how to properly bill for telehealth services on Health Prime´s blog Get paid for telehealth & non-face-to-face visits during COVID-19  

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