Medicare is at the top of the list, the feds say, and more data is needed on quality of care and billing.
Primary care was front and center as the use of telehealth grew in federal health programs during the first year of the COVID-19 pandemic.
Offices of Inspectors General from six federal departments and agencies collaborated on “Insights into Telehealth Use and Risks to Program Integrity in Selected Health Care Programs During the Pandemic.” The study, released this month by the Pandemic Response Accountability Committee (PRAC), examined the use of telehealth, along with the risks of fraud, waste and abuse, in six federal health-related programs.
The overall result is probably no surprise: Telehealth use skyrocketed when medical services warned patients to stay away and patients feared infection.
From March 2020 to February 2021, the report found that a total of 37 million patients used telehealth services, compared with 3 million in the previous 12 months, and the pandemic year programs cost about $6.2 billion.
In a year-over-year comparison, Medicare had the largest growth, with telehealth patients increasing from 341,000 to 28 million, accounting for $5.1 billion in telehealth in the first year of the COVID-19 pandemic.
In Medicare and four other federal health care programs, primary care or office visits with primary care or specialists ranked as the most common use of telehealth.
More research is needed
The PRAC noted that its report does not cover every federal health program or agency, but the numbers could be important to the public debate about future telehealth regulations.
“PRAC’s approach—involving multiple OIGs to provide insight into issues affecting federal agencies—provides a unique opportunity to assess how major changes in health care can affect multiple federal programs and the people they serve,” Kristi A. Grimm, Gen. inspector from the US Department of Health and Human Services (HHS), said in a news release. HHS oversees Medicare spending, and Grimm also directs the PRAC’s health care subgroup.
“The rapid changes and growth of telehealth during the pandemic have raised many questions, and this report provides objective and independent information to policymakers and other stakeholders as they consider the future of telehealth,” Grimm said.
Although there has been research on the effectiveness of telehealth, federal regulators said the programs lack “complete, reliable data” on quality of care and billing that are “critical to conducting oversight of fraud, waste and abuse.”
The other programs included in the study were the TRICARE health care program for active duty military personnel and their families; Office of Personnel Management (OPM) Federal Employee Health Benefits Program; the Veterans Health Administration (VHA); The US Department of Labor (DOL) workers’ compensation programs; and Department of Justice Bureau of Prisons (DOJ-BOP) Inmate Health Services. The DOJ-BOP listed psychiatry as the top use for telehealth, the only one of the six that did not include primary care as the most common type of telehealth service during the survey.
As a percentage of users, VHA has the largest share of telehealth users, with 87% of veterans using telehealth. In Medicare, 43 percent of consumers had telehealth services, fewer than TRICARE (49 percent) but more than the federal employee benefits program (40 percent), DOL (11 percent) and DOJ-BOP (2 percent), said federal study.
Telehealth appears to be already established in VHA care, as VHA had 2.3 million telehealth users before the pandemic, growing to 4.8 million in the first year of the pandemic.
Inspectors general have identified “integrity risks” that are similar across multiple programs. For example, HHS, OPM, and DOL have identified providers that bill at the highest service level for a large portion of telehealth services. HHS identified more than 300 Medicare providers that billed for telehealth services at the highest and most expensive level each time, totaling about $5.2 million.
Other risks include:
- Duplicate claims. HHS identified 138 providers who repeatedly billed Medicare fee-for-service and a Medicare Advantage plan for the same telehealth service, the report said.
- High volume billing, which may indicate billing for services not provided or needed.
- Billing for services that seem inappropriate for telehealth, such as wound debridement or anesthesia.
- Ordering inappropriate durable medical equipment or laboratory tests based on telehealth visits.