Medicare fraud in telehealth stays low in pandemic’s first year

Federal officials found few instances of fraud in Medicare billing practices for telehealth services during the first year of the COVID-19 pandemic.

There were 1,714 providers out of approximately 742,000 whose billing was deemed “high risk” for Medicare, according to a report released this month by the U.S. Department of Health and Human Services’ Office of Inspector General. 

Providers’ billing practices were considered a high risk if they showed concerning billing practices on at least one out of seven measures, such as billing for telehealth services and facility fees for most visits, billing at the most expensive level each time or billing for a high number of days in a year.

The providers in question billed for telehealth services for half a million beneficiaries and received $127.7 million in fee-for-service payments, according to the report.

The Centers for Medicare and Medicaid Services said it will review the high-risk cases.

“Given that this report was conducted outside of CMS’s and law enforcement entities’ program integrity efforts, CMS will need to carefully review the issues identified to assess whether these issues have already been addressed, and if not, whether additional CMS actions are needed,” CMS Administrator Chiquita Brooks-LaSure wrote in a response to the report.

Telehealth exploded in popularity when the pandemic hit, and two-in-five Medicare beneficiaries, or more than 28 million people, used these services in the first year. In that time frame, beneficiaries used telehealth services 88 times more than the previous year, the report found.