OIG: Feds Lack Oversight of Telehealth Services
- By Michelle Dick
- In Audit
- January 26, 2023
- No Comments
More safeguards are needed to strengthen program integrity.
The U.S. Department of Health and Human Services’ (HHS’) Office of Inspector General’s (OIG) Pandemic Response Accountability Committee (PRAC) Health Care Subgroup issued a report, December 2022, revealing telehealth use and integrity risks in six federal agencies during the first year of the COVID-19 public health emergency (PHE).
In the report, Insights on Telehealth Use and Program Integrity Risks Across Selected Health Care Programs During the Pandemic, the OIG explains, “The CARES Act created the PRAC to coordinate oversight of the federal government’s pandemic response and historic level of spending.” In the report, the OIG recommends ways federal programs can strengthen oversight of telehealth claims to reduce fraud and abuse.
Pandemic Healthcare Relies on Telehealth
Shutdowns, quarantines, and social distancing guidelines required businesses and organizations to rely on remote technology to continue operations. With COVID-19 taking its toll on overwhelmed healthcare systems and hospitals, providers turned to telehealth to conduct non-life-threatening medical care. According to the OIG, “Reliance on telehealth services … skyrocketed during the first year of the pandemic, especially among Federal health care programs.”
PRAC OIGs Dig into Telehealth Data
The PRAC’s Health Care Subgroup consists of OIGs that oversee the federal agencies that provide or reimburse for healthcare services. The PRAC Health Care Subgroup reviewed the data on telehealth use during the first year of the pandemic of these six programs:
- Medicare (HHS)
- TRICARE (Department of Defense)
- Federal Employees Health Benefits Program (Office of Personnel Management)
- Veterans Health Administration (Department of Veterans Affairs)
- Office of Workers’ Compensation Programs (Department of Labor)
- Federal Bureau of Prisons and U.S. Marshals Service (Department of Justice)
According to the complete report, the data the six OIGs collected focused on four questions:
- To what extent did the selected programs in six federal agencies make telehealth services available to individuals during the pandemic?
- To what extent did individuals served by the selected programs use telehealth services during the first year of the pandemic?
- What types of program integrity risks are associated with the use of telehealth services?
- What types of data and safeguards could strengthen oversight?
Here’s a look at some of the key findings that were identified for telehealth services during the first year of the pandemic.
Key Point No. 1: Telehealth use increased dramatically.
The number of patients using telehealth during the pandemic was 13 times as high in the prior year with 37 million individuals using it for the selected six federal agency programs. According to Exhibit 8 in the complete report, telehealth services cost these agencies more than $6 billion:
| Medicare | $5.1 billion |
| Federal Employees Health Benefits Program | $646 million |
| TRICARE | $394 million |
| Veterans Health Administration | $62 million |
| DOL Workers’ Compensation Programs | $7.3 million |
| DOJ prisoner health care services | $444,800 |
| TOTAL | $6 billion |
Key Point No. 2: A variety of telehealth services were available to patients. According to Exbibit 7 in the complete report, the top three most common types of telehealth services in each program are:
Medicare:
- Office visits with primary care or specialists
- Virtual care services
- Behavioral health services
TRICARE:
- Primary care
- Mental healthcare
- Specialty care
Federal Employees Health Benefits Program:
- Office visits with primary care or specialists
- Behavioral health services
- Physical therapy, occupational therapy, and speech therapy
Veterans Health Administration (based on data of telehealth services provided directly by VA providers):
- Primary care
- Behavioral health services
- Specialty care
DOL Workers’ Compensation Programs:
- Office visits with primary care or specialists
- Behavioral health services
- Physical therapy, occupational therapy, and speech therapy
DOJ Prisoner Healthcare:
- Psychiatry
- Cardiology
- Nephrology
In Exhibit 7, the OIG notes, “Because of differences in data and analysis, service categories are not the same across all agencies. For example, some programs combine office visits for primary care and specialty care; others analyze these separately.”
Key Point No. 3: Program integrity risks were found that could indicate fraud, waste, or abuse. They include high-volume billing, duplicate claims, and inappropriate charges for the most expensive level of telehealth services. Exhibit 9 in the complete report shows the following examples are program integrity risks associated with billing of telehealth services:
- Upcoding telehealth visits by billing for visits longer than they lasted, or providing basic services and then billing for more complex visits
- Duplicate billing of the same service
- Billing for services that were not provided or not medically necessary
- Billing for services that are not appropriate for telehealth or ineligible for telehealth
- Ordering unnecessary durable medical equipment, supplies, or laboratory tests associated with a telehealth visit
Key Point No. 4: There wasn’t enough data to assess the impact of telehealth on quality of care and to conduct a complete oversight of telehealth services. The programs are looking into safeguards to oversee telehealth services and strengthen program integrity, such as additional monitoring, billing controls, provider education, and collecting additional data related to telehealth data and its impact on quality of care.
Resources
- The Art of Negotiation Starts With an Action Plan - February 1, 2023
- Potential HIPAA Violation Costs Lab $16,500 - January 27, 2023
- OIG: Feds Lack Oversight of Telehealth Services - January 26, 2023
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