• During the first year of the COVID pandemic, 1,714 doctors and health providers billed Medicare nearly $128 million in “high risk” claims, according to a new report from federal investigators.
  • Telehealth industry officials caution against creating “inappropriate barriers” to care, saying the report shows only a small number of providers engage in potential fraud or wasteful billing.
  • More than 28 million seniors and disabled residents on Medicare accessed telehealth in the first year of the pandemic, an 88-fold increase from the previous year.

The federal government eased telehealth requirements at the beginning of the COVID-19 pandemic so more Americans could get remote care with fewer obstacles.

A report by government investigators last week found that more-permissive remote care has come at a price. During the first year of the pandemic, 1,714 doctors and health providers billed Medicare nearly $128 million in “high risk” claims, according to the Department of Health and Human Services Office of Inspector General.

Investigators said less than 1% of the 742,000 Medicare-certified doctors and other providers of telehealth services submitted roughly a half million problematic claims. Yet the billings are concerning enough that government investigators urged the Biden administration to tighten oversight to ensure millions of Americans can access remote care while safeguarding taxpayer dollars.

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“We’re really looking at practices that indicate a high probability of fraud, waste or abuse,” said Andrew VanLandingham, the HHS inspector general’s senior counselor for policy.  

The report comes less than two months after the inspector general’s office alerted medical professionals about rising telemedicine fraud by companies that often pay kickbacks to doctors, labs and others to generate orders paid by Medicare and other federal health programs. Also in July, the Justice Department announced 36 people were charged for over $1 billion in health fraud involving telemedicine providers. Some were part of a telemarketing network that lured thousands of elderly or disabled patients to get unnecessary genetic testing or orders for medical equipment

Medicare fraud, telehealth access and ‘inappropriate barriers’

The latest inspector general report doesn’t address whether doctors or other providers intended to commit fraud, VanLandingham said, but the analysis suggests a high likelihood of billing abuses.

The report informs the Centers for Medicare and Medicaid Services, Congress and other stakeholders of potential ways a small percentage of providers are exploiting Medicare and suggests strategies to tighten oversight during the third year of the pandemic.