Why the OIG Telehealth fraud outcomes could imply extra obstacles to dwelling well being care

A number of health care providers who have billed Medicare for telehealth services likely did so in a fraudulent or wasteful manner, federal regulators said. These and other similar findings dampen the chances of home health care providers being able to charge for virtual care in the future.

That’s a key finding from a recent Office of Inspector General (OIG) report.

The report examines the use of telemedicine by Medicare providers in the first year of the pandemic. The report is based on the analysis of Medicare fee claim data and Medicare Advantage encounter data for the 742,000 providers who billed for a telemedicine service from March 1, 2020 to February 28, 2021.

In response to the COVID-19 emergency, the Centers for Medicare & Medicaid Services (CMS) have implemented a number of measures to temporarily expand access to telemedicine for Medicare beneficiaries.

During this time, CMS also temporarily suspended various program integrity activities, including medical reviews of claims.

OIG saw a dramatic increase in telemedicine usage in the first year of the COVID-19 emergency. Specifically, over 28 million Medicare beneficiaries used telemedicine services in the first year.

In other words, Medicare beneficiaries used 88 times more telemedicine services in the first year of the COVID-19 emergency than the year before.

“The changes to Medicare telehealth policies, along with the dramatic increase in telehealth use, underscore the importance of determining whether providers are appropriately charging for telehealth services and how best to protect Medicare and beneficiaries from fraud, waste and abuse,” OIG wrote in the report.

Overall, the report found that 1,714 providers who billed for telemedicine services during that period posed “high risk for Medicare.”

The 1,714 providers were flagged for at least 1 of 7 measures OIG has developed to flag possible fraud, waste or abuse of telehealth services, according to the report.

In addition, these providers have collected $127.7 million in Medicare service fees and billed approximately half a million beneficiaries for telemedicine services.

Although home health nurses are exempt from these results — since they can’t receive reimbursement for telehealth services under Medicare — it doesn’t bode well for their future.

Legislative efforts to address telemedicine for home health care have largely stalled and been unsuccessful.

In addition, home health care is already seen as a site of rampant scams. In July, the Health & Human Services Office of Inspector General’s (HHS-OIG) annual report focused on a handful of home health-related cases.

Despite the lack of reimbursement, this hasn’t stopped homecare providers from using telemedicine services to improve access to care and deliver services.

According to William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), providers have even provided telemedicine without receiving full payment for those services, which have become an enduring problem for them.

“Both in home nursing and in hospice [agencies] has been providing telehealth services fairly robustly and free of charge during the pandemic,” Dombi previously said. “And so now is the next expectation [they’ll] always do it for free.”

Ultimately, the OIG believes the findings in its report underscore the importance of telemedicine oversight.

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