At the beginning of COVID-19, the federal government eased telehealth requirements, allowing Americans to get remote care with fewer difficulties. A report by government investigators has found indications of widespread fraud committed. In the pandemic's first year, Medicare was billed nearly $128 million in “high risk” claims, said to the Department of Health and Human Services Office of Inspector General. The billings concern investigators, who urged the Biden administration to tighten oversight to ensure millions can access remote care while safeguarding taxpayer dollars, reports USA Today. “We're really looking at practices that indicate a high probability of fraud, waste or abuse,” said HHS's Andrew VanLandingham. The inspector general already had alerted medical professionals about rising telemedicine fraud by companies that often pay kickbacks to doctors, labs and others to generate orders paid by Medicare and other federal health programs. In July, the Justice Department charged 36 people for over $1 billion in health fraud involving telemedicine providers. Some were part of a telemarketing network that lured thousands of elderly or disabled patients to get unnecessary genetic testing or orders for medical equipment.
The new report said a small percentage of providers are exploiting Medicare and suggested strategies to tighten oversight. Examples of misconduct included doctors who charged extra fees, billed the highest and most expensive level of care every time and submitted bills every day of the year. Under Medicare’s fee-for-service billing, doctors are paid for the number of tests, procedures or other services they perform. When patients require a higher level of care, reimbursement is more lucrative. Any decision to extend pandemic-era telehealth rules permanently must be made by Congress. Medicare allowed recipients to get care remotely, often from their home, via a phone call or a video chat. This made it easier for people to get care without the risk of COVID-19 exposure. The expanded telehealth services made it easier for more people in underserved populations and lower-income families to access Medicare and Medicaid. Congress passed a bill to stretch the relaxed telehealth policies five months beyond the public health emergency. Legislation pending in the Senate would continue the policies through 2024.