Several program integrity risks associated with telehealth billing, such as duplicate billing and ordering needless durable medical equipment or laboratory testing, have been revealed in a study by a watchdog committee as telehealth use surged throughout healthcare programs offered by federal agencies.
During the initial year of the COVID-19 pandemic, the Pandemic Response Accountability Committee’s (PRAC) Health Care Subgroup published a study that investigates the usage of telehealth within selected healthcare programs across six federal agencies. The organizations investigated include Medicare, TRICARE, the Federal Bureau of Prisons, the Veterans Health Administration (VHA), the Federal Employees Health Benefits Program, the Office of Workers’ Compensation Programs, and finally the U.S. The DOJ prisoner healthcare services are also known as the Marshals Service.
In the chosen programs run by the six federal agencies, PRAC discovered that almost 37 million people accessed telehealth services between March 2020 and February 2021. This is a significant rise from the 3 million participants in these programs who used telehealth services the previous year. The majority of programs employed telehealth primarily for mental health treatments, such as individual and group therapy and for drug use disorders, as well as office visits with a primary care physician or specialist. The agencies collectively spent more than $6.2 billion on telehealth services, with Medicare spending the most with $5.1 billion, followed by TRICARE with $1 billion, and the Federal Employees Health Benefits Program with $1 billion. However, Prac discovered a number of such program integrity vulnerabilities linked to invoicing for telehealth services across other programs. These included ordering needless durable medical equipment, supplies, or lab tests, “upcoding” telehealth consultations by charging for longer consultations than they really lasted, repeated billing for the same service, and paying for services that were unsuitable or ineligible for telehealth.
The report makes a number of suggestions for further security measures that could strengthen program integrity. Some recommendations include programs that continuously monitor telehealth services, creating extra billing controls including pre-payment modifications, addressing data collection gaps to prevent fraud, waste, and abuse, and collecting data on the grade of care provided through telehealth.