Telehealth providers doing 'more visits than humanly possible' in a day draw CMS scrutiny

CMS Administrator Seema Verma reiterated the success of telehealth during the pandemic and said the agency continues to weigh multiple factors when deciding how to implement permanent telehealth coverage and reimbursement rates, including the potential for fraud, during an interview with Business Insider.

She said the temporary lift of coverage restrictions and pay rate boost during the pandemic allowed virtual visits to surge. Before the pandemic, the agency provided 13,000 telehealth visits per week, while by April 25 it covered 1.7 million virtual visits per week. While she said in the interview that "the case for telehealth is clear" and that Congress ultimately decides which providers can use virtual visits, CMS can change several regulations.

There is some fear among lawmakers that physicians will conduct visits over the phone and then recommend patients come into the office for a separate visit, which would mean CMS pays for two visits instead of one. Congress has been hesitant to permanently cover telehealth at the same rate as in-person visits, thinking it could drive up utilization and costs.

Ms. Verma also told Business Insider that CMS is investigating fraudulent telehealth charges, including providers that bill for "more visits than are humanly possible in a day."

The agency is examining new ways to oversee telehealth to identify and investigate this type of fraud.

But she also clarified that the potential for fraud wasn't enough to block permanent telehealth reimbursement. Instead, she said she sees telehealth as helping health systems transition from fee-for-service and into value-based arrangements where they are paid to keep patients healthier.

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