Telemedicine in OIG’s Crosshairs as Fraud Mounts

When the pandemic hit and a public health emergency was declared, the government began to issue waivers designed to give providers more flexibility in how they could treat patients.

One area that saw restrictions lifted considerably has been telemedicine, an industry that has been gaining traction in recent years. As we wrote about, the use of telemedicine has skyrocketed over the last year, and with it has come an increase in healthcare fraud.

Late last month, HHS-OIG Principal Deputy Inspector General Christi A. Grimm issued a statement that said while his agency “recognizes the promise that telehealth and other digital health technologies have for improving care coordination and health outcomes,†it also recognizes that it has created the potential for more fraud. As a result, Grimm noted that OIG is conducting “significant oversight work assessing telehealth services during the public health emergency.â€

Indeed, in the past few Work Plan Updates issued by OIG, telemedicine fraud has been targeted. In the most recent February update, OIG noted that it will be looking at home health agencies that have been providing telehealth services during the public health emergency.

CMS amended regulations to allow home health agencies to use telecommunications systems in conjunction with in-person visits. The regulations state that the plan of care “must include any provision of remote patient monitoring or other services furnished via telecommunications technology or audio-only technology, and that such services must be tied to patient-specific needs as identified in the comprehensive assessment.†They further state that “telehealth services cannot substitute for a home visit ordered as part of the plan of care and cannot be considered a home visit for the purposes of patient eligibility or payment.â€

OIG said it will be evaluating which types of skilled services were furnished via telehealth, and whether those services were administered and billed in accordance with Medicare requirements. The OIG will report as overpayments any services that were not billed properly.

Also in the February Work Plan, OIG will review the use of telehealth to provide behavioral health services in Medicaid managed care. The review will describe: (1) the challenges that states face using telehealth to provide behavioral health services to Medicaid enrollees; (2) the extent to which states assess the effects of telehealth on access, cost, and quality and monitor telehealth to provide behavioral health services; and (3) how states use telehealth to provide behavioral health services in Medicaid managed care. The information will be used in future decisions to strengthen telehealth on a more permanent basis.

In the January Work Plan, OIG said it will be conducting audits of Medicare Part B telehealth services during the COVID-19 public health emergency. It will be conducted in two phases: Phase one will focus on making an early assessment of whether services such as evaluation and management, opioid use order, end-stage renal disease meet Medicare requirements. Phase two will include additional audits of Medicare Part B telehealth services related to distant and originating site locations, virtual check-in services, electronic visits, remote patient monitoring, use of telehealth technology, and annual wellness visits to determine whether Medicare requirements are met.

In October 2020, OIG stated in its Work Plan that it will review Medicare Parts B and C data to identify program integrity risks associated with Medicare telehealth services during the pandemic. OIG will analyze providers’ billing patterns for telehealth services and describe key characteristics of providers who may pose a program integrity risk to the Medicare program.

Also, in the October Work Plan, OIG will use Medicare Parts B and C data to look at the use of telehealth services in Medicare during the COVID-19 pandemic along with the extent to which telehealth services are being used by Medicare beneficiaries, how the use of these services compares to the use of the same services delivered in-person, and the different types of providers and beneficiaries using telehealth services.

OIG also will be reviewing telemedicine use by those on Medicaid. The watchdog agency stated in June it plans to determine whether state agencies and providers complied with federal and state requirements for telehealth services under the national emergency declaration, and whether the states gave providers adequate guidance on telehealth requirements.

The American Telehealth Association issued a response to Grimm’s announcement stating that it “stands ready to work with OIG and other government agencies to ensure that telehealth services continue to deliver safe, quality and convenient care, and that telehealth becomes permanently available as part of a two-channel care delivery system that balances in-person and virtual care.â€

Grimm pointed out in the letter that these audits should be differentiated from the OIG’s previous high-profile efforts to combat schemes that might mention telehealth, but aren’t really about it.

“OIG has conducted several large investigations of fraud schemes that inappropriately leveraged the reach of telemarketing schemes in combination with unscrupulous doctors conducting sham remote visits to increase the size and scale of the perpetrator’s criminal operations. In many cases, the criminals did not bill for the sham telehealth visit. Instead, the perpetrators billed fraudulently for other items or services, like durable medical equipment or genetic tests. We will continue to vigilantly pursue these “telefraud” schemes and monitor the evolution of scams that may relate to telehealth,†she wrote.

As telehealth grows in popularity, there is a lot at stake and even greater potential for fraud and abuse. Indeed, the federal government has estimated that there was $4.5 billion in telehealth-related fraud losses in fiscal year 2020, the largest of any area of fraud and a record for Medicare fraud.

Having a solid compliance plan in place is the first step to ensure that your telehealth organization is not swept up in government audits. Conducting in-house audits to ensure your telehealth organization is compliant is imperative.

The Health Law Offices of Anthony C. Vitale can assist you in making sure your organization is compliant. Should you become the target of an audit we can represent you. For more information contact us at  305-358-4500 or email info@vitalehealthlaw.com.