Usage of telehealth during the first year of the COVID-19 pandemic raised a number of "integrity risks," according to a report federal watchdogs issued this month.
A coalition of inspectors general from the departments of Defense, Health and Human Services, Justice, Labor, and Veterans Affairs, and the Office of Personnel Management examined telehealth usage across six federal programs during the first year of the pandemic. The offices scrutinized telehealth utilization under Medicare, TRICARE, the Federal Employees Health Benefits Program, the Veterans Health Administration, the Office of Workers' Compensation Programs, the Federal Bureau of Prisons and the U.S. Marshals Service.
The report found that 37 million individuals used telehealth services and that federal programs paid more than $6 billion for them during that time, $5 billion of which Medicare covered. The inspectors general report cites evidence that providers billed more than once for the same services, favored the highest-possible billing codes, and charged for more time than they spent.
"[The inspectors general] identified a provider who treated an individual twice weekly for 45-50 minutes, including phone consultations, but used an inappropriate billing code that represented 60 minutes of psychotherapy,” the report says.
The review also found providers that billed for services that couldn’t possibly be performed via telehealth, such as one provider who submitted a claim for for wound debridement—the removal of dead or unhealthy skin from a wound—via telehealth.
The inspectors general don't offer specific recommendations but wrote that additional safeguards could include additional monitoring of telehealth services and billing controls.
Sending the wrong message?
Advocates for telehealth worry these findings might send the wrong message.
“This is all about perception,” said Krista Drobac, executive director of Alliance for Connected Care, a telehealth lobbying group. “People on [Capitol] Hill are busy. They already have a perception that somehow telehealth creates additional fraud, but it’s not necessarily backed up by a lot of evidence.”
The trade group, which represents a telehealth providers and health insurance companies including CVS Health, Intermountain Healthcare, Walmart and Amwell, maintains fraud is no more likely to occur with telehealth than with in-person care.
Drobac cited the availability of potential safeguards such as IP address matching but deferred to individual providers to speak about the specific guardrails they use.
“As soon as you see some headline about [the Office of Inspector General] saying there needs to be more safeguards in place, it just reinforces existing perception that we don’t think is true,” Drobac said.
According the report, telehealth usage varied widely among program enrollees. While nearly 85% of individuals in the Veterans Health Administration utilized telehealth, only 2% of federal inmates used it. Medicare beneficiaries used more than 114 million telehealth services, mostly for primary care, specialist or behavioral health appointments.
Congress has yet to codify pandemic-era telehealth reimbursement policy. The House passed a bill that extended federal program coverage of telehealth through 2024 but the Senate hasn't taken up the measure.