New OIG Report: An Extremely Low Rate of Telehealth Service Providers Pose a High Risk to Medicare

Expanded access to telehealth services during the pandemic enabled safe delivery of home respiratory therapy supplies and services

WASHINGTON – The Council for Quality Respiratory Care (CQRC) – a coalition of the nation’s leading home oxygen therapy providers and manufacturing companies – today underscored the findings of a new report from the Department of Health and Human Services (HHS) Office of Inspector General (OIG), which found a very limited number of claims for telehealth services pose a high risk to Medicare. The OIG report, Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks, examines the use of telehealth by Medicare beneficiaries during the pandemic and whether providers are billing for telehealth services appropriately.

The OIG identified only 0.23 percent of providers – 1,714 out of approximately 742,000 – whose billing for telehealth services pose a high risk to Medicare. Based on a set of seven measures that focus on different types of billing for telehealth services that may indicate fraud, waste, or abuse, the OIG examined Medicare fee-for-service claims data and Medicare Advantage encounter data for the first year of the pandemic. The OIG states that “high-risk providers represent a small proportion of all providers.”

“The OIG’s latest report on telehealth use, which found an extraordinarily low rate of high-risk billing, indicates that the flexibilities established during the first year of the pandemic are working well and meeting the needs of Medicare beneficiaries, while also maintaining the integrity of the program,” said Crispin Teufel, Chairman of the CQRC. “Telehealth has been an essential tool in enabling providers to reach patients with COPD and other respiratory illnesses who require supplemental oxygen to remain safely in their homes.”

The CQRC has previously praised the Centers for Medicare & Medicaid Services (CMS) for quickly rolling out telehealth waivers that made it easier for physicians to reach home respiratory care patients in need of home respiratory supplies and equipment during the ongoing COVID-19 emergency.

Under the regulatory relaxations, prescribing physicians are able to carry out required face-to-face and follow-up visits for home oxygen and sleep therapies following a physician order via a telehealth visit. Since patients with serious and chronic respiratory illnesses are exceptionally vulnerable to other infections, it is absolutely critical for providers to use telehealth services to minimize patients’ risk, while ensuring they can continue to access the home respiratory therapies prescribed by their physicians.

“We echo the OIG’s recommendation that ‘CMS take appropriate steps to enable a successful transition from current pandemic-related flexibilities to well-considered, long-term policies for the use of telehealth.’ By doing so, providers can continue delivering safe, quality care to respiratory patients across the country,” added Teufel.

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About the Council for Quality Respiratory Care
The CQRC is a coalition of the nation’s seven leading home oxygen therapy provider and manufacturing companies. To learn more, visit cqrc.org and follow CQRC on Twitter at @TheCQRC.