Claims related to remote health service in the FEHB increased by 5,000 percent during the pandemic and are still trending up. Image: Elnur/Shutterstock.com
By: FEDweek StaffThe rapid expansion of telehealth services in the FEHB program due to the pandemic has increased the risks of violations of patients’ privacy and of improper billing, the inspector general’s office at OPM has said.
The report is the latest in a series from the IG calling for controls on costs that are passed on in the form of premiums for both enrollees and the government, following several focusing on ineligible persons getting coverage as family members. The GAO recently issued a similar report on that latter issue.
The auditors said that during the first 16 months of the pandemic, claims related to remote health service in the FEHB increased by 5,000 percent; the rate “continues to trend higher than pre-pandemic levels and we have no reason to believe it will ever return to pre-pandemic levels.”
Before the pandemic, only 1 percent of those covered by FEHB used telehealth services—which most commonly amount to remote office visits and behavioral health services—a figure that rose to 40 percent during the first year and most recently was 24 percent.
However, amid that growth there still are “very few controls in place to protect the confidentiality, integrity, and availability of the technologies used for telehealth sessions,” it said. Some carriers have no controls over recording audio or video during telehealth visits and some do not educate enrollees or providers on telehealth privacy and security risks, it said.
It further said that while OPM encouraged greater use of telehealth it has not specified which procedures are allowable, largely leaving that up to the carriers and even individual provider. That increases “the risk that inappropriately billed procedures will go unidentified” and meanwhile some carriers do not perform check for potentially fraudulent billing patterns—both leaving the program vulnerable to overcharges which would then be passed on to enrollees and the government in the form of higher premiums.
In a sampling of telehealth claims, auditors found more than 2,000 related to services that “could not be performed via telehealth”—including for laser surgery, anesthesia, injections and colonoscopies—and billing for procedures incompatible with the provider’s specialty.
However, OPM management disagreed with the IG’s recommendations in those areas, for example pointing out that telehealth is a well-established concept.
The IG in turn disagreed, saying that “While telehealth is not a new offering in the FEHB, the variety of services offered and the technologies utilized have increased. When combined with the overall increase in telehealth utilization, we believe increased scrutiny and increased protections are both warranted moving forward.”
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