Separating Myth from Reality: Telehealth Expansion and the Potential for Fraud

As the number of telehealth services increased during the COVID-19 public health emergency, so did concerns that such expansion may lead to an increase in fraud and abuse, particularly within the Medicare program. To ascertain whether this increase has been associated with the unnecessary or excessive use of healthcare, health policy researchers from IMPAQ, Index Analytics, and AIR reviewed the accuracy of claims that increased use of telehealth is likely to increase fraud and abuse.

The team (1) reviewed relevant studies from the U.S. Office of the Inspector General (OIG) and the U.S. Government Accountability Office (GAO); (2) conducted interviews with staff from national health systems and with healthcare providers; and (3) identified strategies to increase the integrity of telehealth programs as the use of virtual care becomes more prevalent. Their findings demonstrate that telehealth can be used to deliver timely, person-centered care; generate cost savings; enhance care coordination; and be effectively employed to improve algorithms to detect fraud and ensure program integrity.

This brief:

• Reviews findings from federal investigations of telehealth utilization,
• Synthesizes insights from health systems providing telehealth services during the COVID-19 pandemic, and
• Identifies strategies that will enable the appropriate and effective use of telehealth.