In December 2022, the Pandemic Response Accountability Committee (PRAC) Health Care Subgroup released its report focusing on telehealth fraud, waste, and abuse risks associated with select healthcare programs across six federal agencies during the first year of the COVID-19 pandemic.
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) conducted this report by leading a group of OIGs from each of the six federal agencies involved. Including the HHS OIG, those six federal agencies are the Department of Defense (DoD), the Office of Personal Management (OPM), the Department of Veterans Affairs (VA), the Department of Labor (DOL), and the Department of Justice (DOJ). The report summarizes potential program integrity risks identified by the six participating OIGs. Specifically, the report aims to inform stakeholders how expanded use of telehealth during the COVID-19 pandemic helped individuals access healthcare during uncertain times, while also raising awareness about the critical importance of safeguarding expanded telehealth services against fraud, waste, and abuse.
Among the key findings across federal healthcare programs, the OIGs identified:
- Dramatic increases in the use of telehealth during the first year of the pandemic with approximately 37 million individuals using telehealth across the selected programs, representing 13 times the number of individuals who used telehealth the prior year.
- A variety of telehealth services that were available to patients.
- Similar program integrity risks that might indicate fraud, waste, or abuse, such as high-volume billing, duplicate claims, and inappropriate charges for the most expensive level of telehealth services.
- A lack of data to assess quality of care and conduct comprehensive oversight of telehealth services.
While the selected healthcare programs have some safeguards in place to oversee telehealth services, the report identified additional safeguards that could strengthen program integrity, such as:
- Additional and Ongoing Monitoring: Recognizing that some telehealth monitoring already exists, the OIGs suggested further data analysis measures focusing on program integrity risks. The HHS OIG suggested that Medicare could closely monitor telehealth services to identify providers that pose a risk to the program based on their billing habits and conduct targeted reviews of such providers. The Centers for Medicare & Medicaid Services (CMS) could then use these reviews to pursue overpayment recoveries, identify pre-payment reviews, and conduct fraud investigations of other claims issues.
- Additional Billing Controls: The report suggests that the federal healthcare programs could add billing controls, such as pre-payment edits, to make sure inappropriate payments for telehealth are not issued.
- Provider Education: The report recommends that each federal healthcare program provide more education to both providers and patients. Such education tools could help providers understand how to properly bill for telehealth services, and help individuals be aware of telehealth policies and how to report suspicious billing concerns.
- Further Data Collection and Analysis: The report highlights several areas where the OIGs believe additional data points are necessary to properly guard against fraud, waste, and abuse. For example, HHS OIG recommended collecting data for audio-only telehealth visits data on services that are billed “incident to,” with the goal of improving oversight and understanding how services are being provided.
- Quality of Care Data: The report notes a dearth of information on how telehealth services impact the quality of care received by patients.
For over 35 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters, and our attorneys can assist providers and suppliers in understanding new developments in healthcare law and regulation. If you or your healthcare entity has any questions pertaining to telehealth or healthcare compliance, please contact an experienced healthcare attorney at 248-544-0888 or wapc@wachler.com