OIG: Medicaid telehealth fraud for behavioral health goes unchecked in most states

States must improve how they track telehealth to treat behavioral health among Medicaid enrollees, as most states don't monitor fraud or measure how virtual visits improve patient care and access, HHS' Office of Inspector General said in a Sept. 21 report.

The OIG spoke with Medicaid directors from 37 states that provide telehealth behavioral services to understand how they evaluate their telehealth use. Below are four takeaways:

  1. Twenty-three of the 37 states reported fraud as a major telehealth concern, but just 11 states monitored fraud and waste related to telehealth. The OIG pointed out that even though Medicaid is a joint program run by the federal government and state governments, states are responsible for monitoring telehealth fraud.

    The OIG said fraud monitoring is "essential to ensuring the fiscal integrity of the Medicaid program and to protecting Medicaid enrollees."

  2. Three states were unable to distinguish which services are provided to Medicaid beneficiaries via telehealth compared to in person.

  3. Only two states had evaluated telehealth's effectiveness for improving the quality of and access to behavioral health services. The OIG said measuring quality and access "is particularly important in helping states make decisions about how best to use telehealth and about which populations benefit most from these services."

  4. Only one state evaluated telehealth's effect on cost. It found that before the pandemic, telehealth usage resulted in $8,600 in savings for emergency room care avoidance in one managed care plan and $484,000 in reduced transportation costs for another plan.

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