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Telehealth

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Telehealth

Last Updated: 09-07-2022

Generally, telehealth is the remote or virtual delivery of health care services. Patients can receive a wide range of telehealth services, including check-ins with their primary care providers, mental health care, and specialty services. Similarly, telehealth can be provided through a wide range of technologies, including video chats, remote patient monitoring devices, and phone calls. Read more about the types of telehealth.

The Department of Health and Human Services (HHS) has significant influence on how telehealth services are delivered and paid. For example, the Centers for Medicare & Medicaid Services (CMS) establishes payment and coverage requirements for telehealth services in the Medicare and Medicaid programs, and the Office for Civil Rights establishes privacy and security requirements that affect how telehealth services can be delivered.

More information on Medicare coverage for telehealth services

More information on Medicaid coverage for telehealth services

The COVID-19 pandemic created unprecedented challenges for how patients accessed health care. In response, Congress, HHS, and CMS implemented several flexibilities to expand access to a wide range of services that could be delivered via telehealth. This expansion increased options for health care providers to offer care to beneficiaries enrolled in Federal health care programs, such as Medicare, Medicaid, and the Children's Health Insurance Program (CHIP), remotely during the COVID-19 pandemic.

While the expansion of telehealth has been critical to maintaining beneficiaries' access to care, it is important that new policies and technologies with potential to improve care and enhance access achieve these goals and are not compromised by fraud, abuse, or misuse.

In recent years, the Office of Inspector General (OIG) has conducted dozens of investigations of fraud schemes involving companies and individuals that purported to provide telehealth, telemedicine, or telemarketing services and exploited the growing acceptance and use of telehealth.

OIG encourages Federal health care program beneficiaries and medical providers to be aware of these prevalent schemes. For more information on these fraud schemes, including suspect characteristics related to provider arrangements, please see the Special Fraud Alert: OIG Alerts Practitioners To Exercise Caution When Entering Into Arrangements With Purported Telemedicine Companies.

An illustration of the telefraud scheme

While the facts and circumstances of each case differ, there are some common characteristics of these fraud schemes. For example, telemarketers contact Federal health care program beneficiaries to solicit identifying information related to an individual's health conditions and health insurance number. A purported telehealth company typically then pays a medical provider to review records and electronically sign orders or prescriptions for medically unnecessary durable medical equipment, genetic testing, or prescription medications. The medical provider typically does not interact with or otherwise treat the Federal health care program beneficiary prior to ordering the medically unnecessary items and services. A durable medical equipment company, laboratory, or pharmacy subsequently purchases the complete paperwork package that includes the Federal health care program beneficiary's information and medical provider's order or prescription, and submits false claims for payment to Medicare, Medicaid, and other Federal health care programs.

The following information provides helpful tips that Federal health care program beneficiaries and medical providers can use to distinguish between legitimate telehealth and fraudulent telehealth and telemarketing schemes.

OIG Law Enforcement Actions Related to Telehealth Schemes

Search Enforcement Actions

OIG Oversight Work on Telehealth

OIG is conducting significant oversight work assessing telehealth services, including the impact of the public health emergency flexibilities. These reviews provide objective findings and recommendations that can further inform policymakers and other stakeholders considering changes to telehealth policies. This work can help ensure the potential benefits of telehealth are realized for patients, providers, and HHS programs.

Disclaimer

OIG prepared this educational information as a service to the public and it is not intended to grant rights or impose obligations. These educational materials are general summaries and are not legal documents. These materials are not intended to take the place of the written law or regulations. We encourage readers to review the applicable statutes, regulations, and other interpretive materials for a full and accurate statement of their contents. Although every reasonable effort has been made to assure the accuracy of the information within these materials, the ultimate responsibility for complying with the applicable law lies with the provider of services.

This educational information is available on the OIG Web site and you may reproduce, reprint, and distribute it for educational purposes.