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OIG assesses telehealth risks, CQRC responds 

OIG assesses telehealth risks, CQRC responds 

WASHINGTON – High-risk providers represent a small portion of all providers who billed for a telehealth service, but strong, targeted oversight of these services is still important, according to a new report from the Office of Inspector General. 

The OIG identified 1,714 providers out of about 742,000 whose billing for telehealth services during the first year of the pandemic posed a high risk to Medicare, representing a total of $127.7 million in Medicare fee-for-service payments for about 500,000 beneficiaries. Each had concerning billing on at least one of seven measures that the OIG developed that may indicate fraud, waste, or abuse of telehealth services. 

The agency recommends that CMS (1) strengthen monitoring and targeted oversight of telehealth services, (2) provide additional education to providers on appropriate billing for telehealth services, (3) improve the transparency of “incident to” services when clinical staff primarily delivered the telehealth service, (4) identify telehealth companies that bill Medicare, and (5) follow up on the providers identified in this report. 

CMS concurred with the OIG’s recommendation to follow up on the providers identified in the report but did not explicitly indicate whether it concurred with the other four recommendations. 

The Council for Quality Respiratory Care believes the report’s findings of small number of high-risk providers support extending the flexibilities around telehealth post-public health emergency. 

“The OIG’s latest report on telehealth use, which found an extraordinarily low rate of high-risk billing, indicates that the flexibilities established during the first year of the pandemic are working well and meeting the needs of Medicare beneficiaries, while also maintaining the integrity of the program,” said Crispin Teufel, chairman of the CQRC. “Telehealth has been an essential tool in enabling providers to reach patients with COPD and other respiratory illnesses who require supplemental oxygen to remain safely in their homes.” 

Under the regulatory relaxations, prescribing physicians are able to carry out required face-to-face and follow-up visits for home oxygen and sleep therapies following a physician order via a telehealth visit. 

The CQRC says since patients with serious and chronic respiratory illnesses are exceptionally vulnerable to other infections, it is absolutely critical for providers to use telehealth services to minimize patients’ risk, while ensuring they can continue to access the home respiratory therapies prescribed by their physicians.  


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