OIG: One-Third of Telehealth Claims Do Not Meet Medicare Requirements; Increased Scrutiny May Be Coming

May 4, 2018 | Aging Services Risk, Quality, & Safety Guidance

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​Nearly one-third of telehealth claims sampled by the U.S. Department of Health and Human Services' Office of Inspector General (OIG) did not meet Medicare requirements, according to an April 2018 OIG report. The Centers for Medicare and Medicaid Services (CMS) paid a total of $17.6 million for telehealth services in 2015, compared with $61,302 in 2001. OIG conducted a review of 100 randomly sampled claims from 2014 and 2015 to see whether they met Medicare requirements. Thirty-one claims did not. Nearly a quarter (24) of the sampled claims were not allowable because the beneficiaries received services at nonrural originating sites. Other claims were billed by ineligible providers, for noncovered services, for services provided at unauthorized sites, or for services provided by an unallowable means of communication.

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