Why OIG Telehealth Fraud Findings May Mean Further Roadblocks For Home Health

A number of health care providers that billed Medicare for telehealth services likely did so in a fraudulent or wasteful manner, according to federal watchdogs. That finding and others like it dampen the chances of home health providers being able to bill for virtual care moving forward.

That’s one major takeaway from a recent report from the Office of Inspector General (OIG).

The report examines the use of telehealth among Medicare providers during the first year of the pandemic. The report is based on the analysis of Medicare fee-for-service claims data, and Medicare Advantage encounter data of the 742,000 providers who billed for a telehealth service from March 1, 2020, to February 28, 2021.


As a response to the COVID-19 emergency, the Centers for Medicare & Medicaid Services (CMS) rolled out a number of measures to expand access to telehealth for Medicare beneficiaries on a temporary basis.

During this time, CMS also temporarily paused various program integrity activities, including medical reviews of claims.

OIG saw telehealth use spike dramatically during the first year of the COVID-19 emergency. Specifically, over 28 million Medicare beneficiaries used telehealth services that first year.


In other words, Medicare beneficiaries used 88 times more telehealth services during the first year of the COVID-19 emergency than in the previous year.

“The changes to Medicare telehealth policies, along with the dramatic increase in the use of telehealth, underscore the importance of determining whether providers are billing for telehealth services appropriately and how to best protect Medicare and beneficiaries against fraud, waste, and abuse,” OIG wrote in the report.

Overall, the report found that 1,714 providers who billed for telehealth services during this time period posed “a high risk to Medicare.”

The 1,714 providers were flagged for at least 1 of 7 measures that OIG developed indicating possible fraud, waste or abuse of telehealth services, according to the report.

Additionally, these providers nabbed $127.7 million in Medicare fee-for-service payments and billed for telehealth services for roughly half of a million beneficiaries.

Though home health providers are exempt from these findings — as they don’t have the ability to receive reimbursement under Medicare for telehealth services — it doesn’t bode well for their future.

The legislative efforts around home health telehealth have, largely, been stalled and unsuccessful.

What’s more, home health is already viewed as a site of rampant fraud. In July, the Health & Human Services Office of Inspector General’s (HHS-OIG) annual report zero-ed in on a handful of home health-related cases.

Despite the lack of reimbursement, that hasn’t stopped home health providers from utilizing telehealth services to increase access to care and deliver services.

In fact, providers have even delivered telehealth without receiving full pay for these services, which have become a lasting problem for them, according to National Association for Home Care & Hospice (NAHC) President William A. Dombi.

“Both in home health and in hospice, [agencies] delivered telehealth services quite robustly during the pandemic for free,” Dombi previously said. “And so now the next expectation is [they’ll] always do it for free.”

Ultimately, OIG believes that the findings in its report underscore the importance of telehealth oversight.

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