September 7, 2022, Washington, D.C. – The only way to truly understand the impact of covering telehealth in Medicare on fraud is the analysis of real data. The HHS Office of the Inspector General (OIG) continues to do just that, and we applaud their efforts. These reports add to the growing body of evidence showing that telehealth meaningfully expands access to care, and that long-term telehealth expansion is feasible with some limited steps to ensure continued oversight and evaluation.

We agree with most of the findings and recommendations of HHS Office of the Inspector General (OIG) thus far, and look forward to a more conclusive finding that covering treatment of seniors virtually does not uniquely expose Medicare to fraud.

The reports released today build on the OIG report “Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic” from earlier this year. The new reports include:

  • HHS OIG: Certain Medicare Beneficiaries, Such as Urban and Hispanic Beneficiaries, Were More Likely Than Others To Use Telehealth During the First Year of the COVID-19 Pandemic
  • OIG Report: Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks

The Alliance was pleased to see the continued evaluation of beneficiary access through telehealth show that that dually-eligible beneficiaries, and some minority populations were more likely than others to use telehealth to ensure access to care. The finding that audio-only services benefitted older beneficiaries, the dually eligible, and Hispanic populations emphasize the importance of maintaining access to audio-only telehealth services. While OIG found greater utilization of telehealth in urban areas, we believe this number is likely skewed by the effect of COVID-19 on urban populations, rather than to indicate any long-term utilization trend. OIG made the following subsequent recommendations:

  1. Take appropriate steps to enable a successful transition from current pandemic-related flexibilities to well-considered long-term policies for the use of telehealth for beneficiaries in urban areas and from the beneficiary’s home,
    • The Alliance agrees with this recommendation
  2.  Temporarily extend the use of audio-only telehealth services and evaluate their impact,
    • The Alliance agrees with this recommendation
  3. Require a modifier to identify all audio-only telehealth services provided in Medicare, and
    • The Alliance supported a modifier in our 2023 Physician Fee Schedule comments
  4. Use telehealth to advance health care equity.
    • The Alliance strongly agrees that telehealth can help reach underserved populations

The Alliance also appreciated OIG’s evaluation of program integrity risks related to telehealth during the COVID-19 pandemic. OIG examined a selected group of providers that they believe pose a higher risk to the Medicare program, but did not draw any conclusions around the use of telehealth and if there is any relation to fraud. OIG recommends the following actions:

  1. Strengthen monitoring and targeted oversight of telehealth services,
    • The Alliance has supported additional oversight to ensure bad actors do not undermine access to telehealth in Medicare.
  2. Provide additional education to providers on appropriate billing for telehealth services,
    • The Alliance strongly agrees that provider education is useful, as accidental misbilling has in the past been interpreted as fraudulent. Similarly, HHS steps to simplify telehealth billing are welcomed.
  3. Improve the transparency of “incident to” services when clinical staff primarily delivered the telehealth service,
    • The Alliance recognizes the importance of accurate data for analysis. We also stress the importance maintaining “incident to” services for healthcare practitioners unable to bill the Medicare program directly.
  4. Identify telehealth companies that bill Medicare, and
    • If a provider, including a virtual-only provider, wants to bill Medicare directly, they must enroll in Medicare, thereby giving CMS oversight of that provider. We don’t believe there is clear justification for singling out virtual-only providers, particularly when Medicare beneficiaries are overwhelmingly seeing providers that use telehealth services in addition to maintaining brick and mortar. Given that virtual-only is a new modality, limited steps to improve CMS’s understanding and oversight of these providers seems logical, and if it helps prevent limits on beneficiary access to telehealth, then we support it.
  5. Follow up on the providers identified in this report.
    • The Alliance supports OIG investigations into fraudulent behavior in the Medicare program, because these investigations are necessary to differentiate between possible telehealth services issues and much more likely marketing fraud that OIG has continued to identify and report on.