On April 25, 2023, the Department of Health and Human Services Office of Inspector General published a toolkit titled "Analyzing Telehealth Claims to Assess Program Integrity Risks" at https://oig.hhs.gov/oei/reports/OEI-02-20-00723.pdf. The toolkit provides ways to analyze telehealth claims to identify possible improper billing for telehealth services for individual providers, such as physician and non-physician practitioners. The toolkit was created to help Medicare Advantage plan sponsors, private health plans, state Medicaid Fraud Control Units, and other federal healthcare agencies in reviewing telehealth claims for accuracy and appropriate billing.
Due to the drastic increase in telehealth claims during the COVID-19 pandemic, the increase in potential fraud, waste, and abuse of federal and state healthcare programs also grew exponentially. Payers can utilize this toolkit to validate appropriate claims, and providers and hospitals can also use it to review telehealth claims for potential billing issues to mitigate risks. The toolkit provides seven program integrity measures as potential fraud, waste, and abuse.
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