Insights on Telehealth Use and Program Integrity Risks Across Selected Health Care Programs During the Pandemic

WHY WE DID THIS STUDY

As part of the Pandemic Response Accountability Committee (PRAC) Health Care Subgroup, the Department of Health and Human Services' Office of Inspector General (OIG) led a group of OIGs in producing this PRAC-issued report focusing on telehealth across selected health care programs in six Federal agencies during the first year of the COVID-19 pandemic.

The pandemic changed many aspects of our lives, including how we visit the doctor and other health care providers. Reliance on telehealth services—that is, health care services that are provided remotely using technology between a provider and a patient—skyrocketed during the first year of the pandemic, especially among Federal health care programs.

The PRAC's Health Care Subgroup developed this report to provide policymakers and stakeholders—such as Congress; Federal and State agencies; and health care organizations—with information about the nature of telehealth and its use across selected health care programs in six Federal agencies during the first year of the pandemic. The report also provides insights into the program integrity risks associated with telehealth and safeguards that could strengthen oversight in these programs.

HOW WE DID THIS STUDY

The PRAC Health Care Subgroup comprises six OIGs responsible for the oversight of agencies that provide or are involved with the provision of health care services. For this review, the six OIGs selected programs or components within their agencies for which they could obtain data on the use of telehealth during the first year of the pandemic. These programs were Medicare (Department of Health and Human Services); TRICARE (Department of Defense); the Federal Employees Health Benefits Program (Office of Personnel Management); the Veterans Health Administration (Department of Veterans Affairs); the Office of Workers' Compensation Programs (Department of Labor); and the Federal Bureau of Prisons and U.S. Marshals Service (Department of Justice).

INSIGHTS

• The selected programs in six Federal agencies took steps to make telehealth available during the COVID-19 pandemic and provided relatively similar coverage of telehealth services.
• All selected programs experienced dramatic increases in the use of telehealth during the first year of the pandemic. During this time, approximately 37 million individuals used telehealth across the selected programs in six Federal agencies, 13 times the number who used telehealth the prior year.
• OIGs identified several program integrity risks associated with billing for telehealth services that were similar across multiple health care programs, such as risks involving inappropriate billing for the highest, most expensive level of telehealth services and risks related to duplicate claims and high-volume billing.
• OIGs found limited information about the impact of telehealth on quality of care, which has implications for the care provided to individuals and program integrity.
• OIGs found that programs lack some data necessary for oversight of telehealth services.
• The selected health care programs have some safeguards in place to oversee telehealth services, but additional safeguards could strengthen program integrity. For example:
  • Programs could conduct additional monitoring of telehealth services.
  • Programs could develop additional billing controls to prevent inappropriate payments for telehealth services.
  • Programs could conduct efforts to educate providers and individuals about telehealth services.
  • Programs could collect additional data related to telehealth services.
  • Programs could collect and review information about the impact of telehealth services on quality of care.
• Together, these insights demonstrate the importance of ensuring the benefits of telehealth are realized while minimizing the risk in an effective and efficient manner.

This report contained no recommendations.