On April 20, 2023, the United States Department of Health and Human Services Office of the Inspector General (HHS OIG) released a new toolkit designed to help analyze telehealth claims to assess federal healthcare program integrity risks. The toolkit is OIG’s latest action in its continued focus on telehealth services that OIG considers to be high risk. The toolkit is based on methodologies highlighted in OIG’s September 2022 data brief, which identified billing practices by Medicare providers that OIG was concerned posed a high risk to program integrity based on a review of Medicare fee-for-service claims data and Medicare Advantage data from March 1, 2020, through February 28, 2021 (OIG Data Brief). The September 2022 OIG Data Brief is discussed in detail in this prior On The Subject article.
OIG intends for the toolkit to be used by public and private parties, including Medicare Advantage plan sponsors, private health plans, State Medicaid Fraud Control Units, and other federal healthcare agencies to analyze program integrity risks and identify providers whose billing may pose a high risk and warrant further scrutiny.
