HHS OIG flags $1.96M telehealth errors
- The Health and Human Services inspector general said Medicare paid for virtual check-ins and e-visits that may have broken billing rules. - Auditors found $2.26 million in potentially improper payments, including $1.96 million for 173,287 virtual check-ins and $298,200 for 10,237 e-visits. - The report targets CMS safeguards for brief telehealth billing, not Medicare’s broader telehealth coverage. (oig.hhs.gov)
The Department of Health and Human Services inspector general said Medicare paid $2.26 million for brief telehealth services that may not have met billing rules. (oig.hhs.gov) The audit, issued April 23 and posted April 28, 2026, examined Medicare Part B claims for virtual check-ins and e-visits. Auditors said the biggest issue was $1,964,125 tied to 173,287 virtual check-in services. (oig.hhs.gov) They also identified $298,200 in potentially improper payments for 10,237 e-visit services. The report said Medicare Administrative Contractors and the Centers for Medicare & Medicaid Services lacked system edits to catch some claims at risk of noncompliance. (oig.hhs.gov) A virtual check-in is a short patient-initiated contact, often five to 10 minutes, with a clinician. Medicare has paid for these services since 2019, and the billing rule says they cannot be separately billed if they are tied to a related evaluation and management visit in the previous seven days or the next 24 hours. (cms.gov) (oig.hhs.gov) The inspector general said many flagged claims were billed too close to office visits for the same diagnosis. Of the virtual check-in claims identified, 120,316 related evaluation and management services were also billed and paid with an unnecessary modifier. (oig.hhs.gov) E-visits work differently: they are patient-initiated messages through an online portal and are billed based on cumulative clinician time over seven days. The inspector general said some of those claims may also have overlapped with other billable care. (cms.gov) (oig.hhs.gov) Auditors recommended that CMS develop edits to flag suspect claims, educate providers on billing requirements, and instruct contractors to recover overpayments where appropriate. CMS concurred with the recommendations, according to the report summary. (oig.hhs.gov) The audit lands after a coding change that replaced HCPCS code G2012 with CPT code 98016 for virtual check-ins on January 1, 2025. The findings focus on guardrails around a narrow slice of low-cost telehealth billing, not on ending Medicare payment for telehealth more broadly. (pbn.decisionhealth.com) (cms.gov)
