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WASHINGTON — Washington’s attempts to permanently lock in telehealth coverage have been hobbled by a fear that virtual care could drive up Medicare fraud and spending. But a new watchdog report offers early evidence that only a small portion of providers are billing for virtual care in a potentially fraudulent way, suggesting that targeted interventions could crack down on abuse.

Some Medicare-certified providers — just about 1,714 out of 742,000 — billed for telehealth in a way indicating high risk of fraud, waste or abuse during the pandemic’s first year, according to the Department of Health and Human Services’ Office of the Inspector General’s analysis of fee-for-service Medicare claims. Those providers billed roughly half a million Medicare beneficiaries for almost $130 million. The analysis doesn’t account for the dollar amount of Medicare Advantage claims, but does include encounter data.


While the scale of the concerning billing is relatively small compared to total Medicare spending  — hundreds of billions a year — the analysis sheds light on buckets of patterns, such as providers charging location-based fees erroneously. And taken in conjunction with another recent OIG analysis which found that urban Medicare beneficiaries were more likely than rural ones to use telehealth, lawmakers are getting a clearer picture of who uses telehealth and what risks the billing process poses, OIG staffers told STAT.

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