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HHS OIG Says Medicare Paid $3.7 Million in Improper Telehealth Claims

The Health and Human Services (HHS) Department’s Office of the Inspector General (OIG) recently released a report titled “CMS Paid Practitioners for Telehealth Services That Did Not Meet Medicare Requirements.”

Of the 100 telehealth claims that the HHS OIG audited for services provided from 2014-2015, 31 did not meet Medicare requirements for payment. The HHS OIG estimated that Medicare was overcharged by $3.7 million.

Most of the noncompliant claims (24) were related to telehealth services not originating outside of a metropolitan statistical area or in a health professional shortage area. These nonrural originating sites are not in compliance with current Medicare telehealth rules.

Medicare reimbursement for telehealth services has increased dramatically in the past decade, with $17.6 million in such payments in 2015. That figure was just $61,302 in 2001. The OIG recommends that the Centers for Medicare and Medicaid Services conduct reviews to detect ineligible payments and offer education for providers to improve compliance.

Robert B. Vogel, MD, JD
Retinal Ophthalmologist at Piedmont Eye Center, Lynchburg VA;
Attorney, Overbey Hawkins & Wright, PLLS, Lynchburg, VA;
Adjunct Professor, Humanities and Bioethics, Liberty University School of Medicine, Lynchburg, VA.