Federal report finds telehealth fraud during pandemic cost Medicare $128 million

The federal government eased telehealth requirements at the beginning of the COVID-19 pandemic so more Americans could get remote care with fewer obstacles.
A report released last week by federal government investigators found that nearly $128 million in telehealth claims submitted during the first year of the pandemic may have been fraudulent (Source: “'Guardrails' needed? Telehealth fraud cost Medicare $128M in first year of COVID pandemic, feds say,” USA Today, Sept. 11).
Investigators said less than 1% of the 742,000 Medicare-certified doctors and other providers of telehealth services submitted roughly a half million problematic claims. Yet the billings are concerning enough that government investigators urged the Biden administration to tighten oversight to ensure millions of Americans can access remote care while safeguarding taxpayer dollars.
Before 2020, Medicare largely restricted telehealth to people who accessed medical care via video and audio connections set up in rural clinics. Amid the pandemic, Medicare allowed recipients in cities and suburbs to get care remotely, often from their home, via a phone call or a video chat. Medicare also more than doubled the types of services eligible for reimbursement to make it easier for people to get care without the risk of COVID-19 exposure during a visit to a clinic or hospital.

State Medical Board extends COVID-19 telemed rules through March 2022

The State Medical Board of Ohio on Wednesday delayed the scheduled expiration of COVID-19 emergency rules that allow for more liberal use of telemedicine, meaning Ohioans will be able to continue using telemedicine through March 2022 for doctor visits that involve prescribing drugs or renewing medical marijuana cards (Source: “Ohio COVID-19 telemed rules for medical pot, drug prescriptions extended through March 2022,” Columbus Dispatch, Nov. 10).

The extension comes as state lawmakers debate a bill that would make the COVID-19 emergency telemedicine rules permanent. 

In March 2020, as the COVID-19 pandemic took off, the medical board lifted a requirement that Ohioans must see a doctor in-person to prescribe a drug or renew medical marijuana cards. The in-person visit rule was set to expire Sept. 17 after Gov. Mike DeWine ended the COVID-19 emergency declaration. But health care organizations pushed to keep the flexibility since the virus was still circulating. The board delayed the expiration to the end of the year until Wednesday's move to extend it.

States begin lifting temporary telehealth rules waivers

States have begun rolling back pandemic workarounds for telehealth that temporarily waived rules requiring licensed clinicians to hold a valid license in the state where their patient is located (Source: “Telehealth’s Limits: Battle Over State Lines and Licensing Threatens Patients’ Options,” Kaiser Health News, Aug. 31).

At least 17 states, including Ohio, still have waivers in effect, according to a tracker maintained by the Alliance for Connected Care, a lobbying group representing insurers, tech companies and pharmacies.

As those rules end, “it risks increasing barriers” to care, said Dr. Brian Hasselfeld, medical director of digital health and telemedicine at Johns Hopkins.

The rollbacks come amid a longer and larger debate over states’ authority around medical licensing that the pandemic — with its widespread adoption of telehealth services — has put front and center.

“Consumers don’t know about these regulations, but if you all of a sudden pull the rug out from these services, you will definitely see a consumer backlash,” said Dr. Harry Greenspun, chief medical officer for the consultancy Guidehouse.

Trump administration greenlights Medicare telehealth services in rural areas

The Trump administration is taking steps to give telehealth a broader role under Medicare, with an executive order that serves as a call for Congress to make doctor visits via personal technology a permanent fixture of the program (Source: “Trump wants broader role for telehealth services in Medicare,” Associated Press, Aug. 3).

The order President Donald Trump signed on Monday applies to one segment of Medicare recipients — people living in rural communities. But administration officials said it’s intended as a signal to Congress that Trump is ready to back significant legislation that would permanently open up telehealth as an option for all people with Medicare.

Monday’s executive order will also set in motion an experiment under which hospitals in rural communities could receive a more predictable stream of Medicare payments in exchange for delivering better performance on certain measures of quality.

Telemedicine booms during pandemic, expected to stay

With relaxed state and federal rules aimed at enabling distancing during the COVID-19 pandemic, telemedicine use has greatly expanded in Ohio and nationally (Source: “Rebuilding America: Telemedicine use prompted by COVID-19 here to stay, doctors and health care officials say,” Columbus Dispatch, May 28, 2020)

The necessity to isolate led to a sudden relaxation of federal privacy rules that had prohibited some less-secure forms of patient/doctor communication like FaceTime and not allowing doctors to communicate from home, where others might overhear. More importantly, the rules have been relaxed so that Medicaid and private insurers who previously wouldn’t pay for most virtual health-care visits now do so.

Those changes led to an explosion of telemedicine use. And doctors and health care experts say there will be no going back. This, they say, is a seminal moment for medicine.

Telehealth appointments could serve a more important role in the coming weeks as more people come into hospitals for elective surgeries. Gov. Mike DeWine removed restrictions May 1 on elective surgeries in the state. To reduce risk of exposure, patients might be encouraged to do their presurgery appointments from home.

CMS relaxes rules, allows telemedicine practice across state lines

The Trump administration has relaxed rules to enable doctors to remotely care for patients across state lines at rural facilities and let nurse practitioners perform more duties as workforce capacity becomes a major concern (Source: “CMS relaxes rules to boost capacity of providers as facilities tackle COVID-19 outbreak,” Fierce Healthcare, April 9, 2020).

The Centers for Medicare & Medicaid Services (CMS) announced a series of rules that will be relaxed for the duration of the public health emergency. The agency is trying to remove regulatory burdens facing providers swamped with treating the COVID-19 outbreak.

“It’s all hands on deck during this crisis,” said CMS Administrator Seema Verma in a statement. “All frontline medical professionals need to be able to work at the highest level they were trained for.”

Telehealth use rapidly expands in Ohio during pandemic

The COVID-19 outbreak is fueling an expansion of telehealth as state and federal officials seek to reduce the strain on the health care system (Source: “Coronavirus spurs growth of telehealth in Ohio,” Columbus Dispatch, March 26, 2020).

Allowing patients to meet with a doctor and get medical services via online video conferencing increases access to care while limiting face-to-face interactions that would occur during office or hospital visits, with the goal of reducing the risk of spreading the disease. It also can preserve personal protection equipment, which is in short supply.

As thousands more Ohioans turn to tax-funded Medicaid for health coverage during the pandemic, Gov. Mike DeWine signed an order last week to expand opportunities for telehealth for the program’s roughly 3 million beneficiaries.

In addition, Ohio Medicaid Director Maureen Corcoran told caseworkers at the county level to suspend annual renewals required to maintain coverage and to focus on enrolling newly eligible applicants as quickly as possible. Applications for the health insurance for the poor and disabled jumped 25% last week from the previous week.

Feds move forward with plan for national 3-digit suicide hotline

With suicides on the rise, the U.S. government wants to make the national crisis hotline easier to reach (Source: “Gov't wants a new 911-like number just for suicide hotline,” Toledo Blade, Aug. 15, 2019).

Once implemented, people will just need to dial 988 to seek help. Currently, the National Suicide Prevention Lifeline uses a 10-digit number, 800-273-TALK (8255). Callers are routed to one of 163 crisis centers, where counselors answered 2.2 million calls last year.

A law passed last year required the Federal Communications Commission to study assigning a three-digit number for suicide prevention, like 911 for emergencies or 311 for city services. The FCC said in a Wednesday report that there is “overwhelming support” for a three-digit number because it would be easier for distressed people to get help.

Feds to prioritize telemedicine funding based on ‘rurality’

The Federal Communications Commission is moving forward with plans to reform how funding is distributed for the agency's rural telemedicine program (Source: “FCC to prioritize telemedicine funding by 'rurality',” Modern Healthcare, Aug. 1, 2019).

The FCC on Thursday voted to adopt a report and order for its Rural Health Care Program, which helps fund broadband and telecommunications services for some healthcare providers in rural areas. A major part of the program involves subsidizing the difference between urban and rural rates for telecommunications services.

To address increasing demand for the program, last summer the FCC increased funding for the Rural Health Care Program to $571 million per year, up from its initial funding cap of $400 million.

With the new report and order, the FCC said it will reform the way it distributes Rural Health Care Program funding and take steps to guard against possible waste and inefficiencies in program costs.

In the event program demand outpaces available funding, the FCC now plans to prioritize support based on "rurality tiers," as well as whether the Health Resources and Services Administration designates a provider's area as part of a medically underserved population.

DeWine budget includes requirement for expanded telemedicine coverage

More Ohio insurers would be required to cover virtual doctor’s visits just like they would any other medical appointment, under a proposal from Gov. Mike DeWine that’s backed by some of Ohio’s largest health-care providers (Source: “DeWine administration seeks expansion of insurance coverage for virtual doctor’s visits,” Cleveland Plain Dealer, April 10, 2019).

In an interview, Lt. Gov. Jon Husted said expanding telemedicine coverage would increase convenience for patients, broaden access for people in rural areas and decrease the likelihood that people visit the emergency room for routine health care. He said telemedicine, an emerging trend in health care, especially shows promise for addiction and other mental-health treatment.

The DeWine administration has proposed requiring that ”health benefit plans” cover telemedicine “on the same basis and to the same extent as in-person services.” The proposal only would affect state-regulated insurance plans — individual, small group and large-group plans — which cover roughly 1.7 million people, or about one-quarter of all Ohioans with private insurance.

Many insurers already cover telemedicine to varying degrees, but specifics of what the coverage actually entails varies. The telemedicine proposal, backed by the Cleveland Clinic and other large health-care providers, appears in the DeWine administration’s budget bill. Identical language appeared in a bill, sponsored by Strongsville Rep. Tom Patton, that cleared the Ohio House last year, but the measure died in the Senate.