OIG on telehealth: Bennies stick with established providers

WASHINGTON – The majority of Medicare beneficiaries (84%) received telehealth services only from providers with whom they had an established relationship, the Office of Inspector General has found. Those enrolled in traditional Medicare were more likely to receive services from providers with whom they had an established relationship compared to beneficiaries in Medicare Advantage, it found. “This pattern persisted among virtually all of the most common telehealth services,” the OIG states in its study. “Beneficiaries tended to see their providers in person about four months prior to their first telehealth service, on average.” To conduct the study, the OIG reviewed Medicare claims data for telehealth services provided from March through December 2020. It determined the proportion of beneficiaries who received telehealth services only from providers with whom they had an established relationship and looked for any differences among the 10 most common types of telehealth services, and between beneficiaries enrolled in traditional Medicare and those enrolled in Medicare Advantage. For beneficiaries who had an established relationship with their providers, it determined the average amount of time between their first telehealth service and their most recent in-person visit for each of their providers. “(This) data can be used to inform decisions about how to best use telehealth in Medicare and should be taken into account as policymakers continue to examine telehealth utilization and concerns about telehealth being vulnerable to fraud, waste and abuse,” the OIG states. “This includes decisions about which services to allow to be delivered via telehealth on a more permanent basis and to what extent Medicare should require that beneficiaries have a relationship with their providers prior to receiving certain telehealth services.”