More than 40% of Medicare beneficiaries used telehealth services during the first year of the COVID-19 pandemic. 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. 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:
- Strengthen monitoring and targeted oversight of telehealth services,
- Provide additional education to providers about appropriate billing for telehealth services,
- Improve 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.
September 14, 2022 – C. St. John
 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
 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