The Centers for Medicare and Medicaid Services paid practitioners about $3.7 million for some telehealth claims associated with services that did not meet Medicare requirements, according to an audit by the Department of Health and Human Services’ Office of Inspector General.
OIG selected a random sample of 100 claims and found that nearly a third were not in compliance with regulations. In particular,
- 24 claims were unallowable because the beneficiaries received services at non-rural originating sites.
- Seven claims were billed by ineligible institutional providers.
- Three claims were for services provided to beneficiaries at unauthorized originating sites.
- Two claims were for services provided by an unallowable means of communication.
- One claim was for a non-covered service.
- One claim was for services provided by a physician located outside the United States.
“For 24 claims, beneficiaries received services in non-rural settings at sites that were not participating in a demonstration program,” states the report. “In one example, a patient’s originating site was a physician’s office in Lynchburg, Virginia, which is within a (metropolitan statistical area). The results of the Medicare Telehealth Payment Eligibility Analyzer for each of these 24 originating-site locations indicated that ‘the address provided is not eligible for Medicare telehealth payment.’ ”
Auditors recommended that CMS take these three corrective actions:
- Conduct periodic post-payment reviews to disallow payments for errors for which telehealth claim edits cannot be implemented.
- Work with Medicare contractors to implement all telehealth claim edits listed in the Medicare Claims Processing Manual.
- Offer education and training sessions to practitioners on Medicare telehealth requirements and related resources.
CMS officials were not immediately available for comment on the findings. However, in its written response to the OIG, the agency concurred with the auditors’ recommendations and described corrective actions it had taken or planned to take.
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