HHS develops new measures that could indicate fraud, abuse, or waste.
Federal inspectors flagged as “high risk” 1,714 health care providers who billed Medicare for telehealth services worth $127.7 million during the COVID-19 pandemic.
The U.S. Department of Human Services’ Office of the Inspector General (HHS-OIG) developed seven measures that could indicate fraud, waste, or abuse of telehealth services, according to a new study published this month.
The findings did not confirm particular health care providers were engaging in fraud. But “all of these providers warrant further scrutiny. For example, they may be billing for telehealth services that are not medically necessary or were never provided,” OIG said in a news release accompanying the study.
CMS will follow up on the providers identified in the report, but has not concurred with four other OIG recommendations to bolster oversight and minimize risk:
The report follows the announcement this summer that federal investigators netted a record $5 billion in health care fraud judgments and settlements in the last year. About two weeks later, the U.S. Department of Justice, with HHS and the Centers for Medicare & Medicaid Services (CMS), announced new allegations of medical fraud tallying more than $1.2 billion by 36 defendants across the country.
HHS this summer published a new advisory with clues about fraud that physicians should look for when engaging in telehealth services.
“Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks” examined billing by about 742,000 providers from March 1, 2020, to Feb. 28, 2022. OIG acknowledged those deemed “high risk” were a small proportion of all providers, but the findings show the need for strong, targeted oversight for telehealth services.
The measures and findings included: