Medicaid and Medicare Telehealth Payments Fails to Meet Medicare Requirements

OIG reviewed 191,118 Medicare paid distant-site telehealth claims, totaling $13.8 million, that did not have corresponding originating-site claims. The watchdog agency then reviewed provider supporting documentation to determine whether the services met Medicare’s requirements for reimbursement. 31% of the telehealth claims did not. Specifically:

24% were unallowable because the beneficiaries received services at nonrural originating sites
7% were billed by ineligible institutional providers
3% were for services provided to beneficiaries at unauthorized originating sites
2% were for services provided by an unallowable means of communication
1% was for a noncovered service
1% was for services provided by a physician located outside the United States
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