On December 1, 2022, the Pandemic Response Accountability Committee (PRAC) Health Care Subgroup published a report about the use of telehealth in selected health care programs across six federal agencies during the first year of the COVID-19 pandemic. The report identifies several program integrity risks associated with billing for telehealth services that were similar across multiple health care programs, such as risks involving inappropriate billing for the highest, most expensive level of telehealth services and risks related to duplicate claims and high-volume billing.

The PRAC Health Care Subgroup consists of the offices of the inspectors general of six agencies responsible for the oversight of agencies that provide or are involved with the provision of health care services. These agencies are the Department of Health and Human Services, the Department of Defense, the Office of Personnel Management, the Department of Veterans Affairs, the Department of Labor, and the Department of Justice.

The PRAC Health Care Subgroup developed the report to inform policymakers and stakeholders, such as Congress, Federal and State agencies, and health care organizations, with information about the nature of telehealth and to provide insight into the program integrity risks associated with telehealth. The selected programs include Medicare, TRICARE, the Federal Employees Health Benefits Program, the Veterans Health Administration, the Office of Workers’ Compensation Programs, and the Federal Bureau of Prisons and U.S. Marshals Service.

The report identifies several program integrity risks associated with billing of telehealth services, including:

• “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, which may indicate that providers are intentionally billing twice to increase their payments;

• billing for services that were not provided or not medically necessary;

• billing for services that are seemingly not appropriate for telehealth or ineligible for telehealth; and

• ordering unnecessary durable medical equipment, supplies, or laboratory tests associated with a telehealth visit.

In addition to identifying program integrity risks, some of the inspector general offices also identified specific providers with telehealth billing practices that raise concern and may indicate fraud, waste and abuse. While the report does not identify suspect providers by name, there is reason to believe that such providers may face further scrutiny. For example, in a related report issued in September, HHS OIG referred to CMS the telehealth providers it identified as posing a high risk to Medicare and recommended that CMS take appropriate action. That report is available here.

The inspector general offices also found limited information about the impact of telehealth on quality of care, which has implications for the care provided to individuals and program integrity. Various inspector general offices noted the need for studies, assessments, and more robust data to evaluate the effect of telehealth on quality of care.

Additionally, most inspector general offices found the programs they oversee lack some data necessary for oversight of billing for telehealth services. They noted that (i) DOJ lacks comprehensive data on telehealth services, (ii) Medicare lacks data on some providers who render telehealth services, and (iii) Department of Defense’s oversight data does not always distinguish telehealth from in-person care.

The report also identifies potential safeguards that could strengthen oversight in the selected programs. Although the inspector general offices acknowledge that the selected programs have some safeguards in place to oversee telehealth services, they conclude that additional safeguards could strengthen program integrity. For example, the inspector general offices stated that programs could:

• conduct additional monitoring of telehealth services;

• develop additional billing controls to prevent inappropriate payments for telehealth services;

• conduct efforts to educate providers and individuals about telehealth services;

• collect additional data related to telehealth services; and

• collect and review information about the impact of telehealth services on quality of care.

The PRAC Health Care Subgroup report is available here.