From the U.S. Government Accountability Office, www.gao.gov Transcript for: Telehealth Use Surged During the Pandemic Among Medicaid Beneficiaries Description: Telehealth boomed during the pandemic—including among Medicaid beneficiaries. However, there are some concerns about the quality of care that patients received, and even fraudulent billing by some service providers. We find out more from GAO's Carolyn Yocom, an expert on Medicaid health care policy. Related GAO Work: GAO-22-104700, Medicaid: CMS Should Assess Effect of Increased Telehealth Use on Beneficiaries' Quality of Care Released: March 2022 [Carolyn Yocom:] Telehealth is a valuable tool However, like any tool, we need to assess when it's useful and when it isn't. [Holly Hobbs:] Hi, and welcome to GAO's Watchdog Report—your source for news and information from the U.S. Government Accountability Office. I'm your host Holly Hobbs. During the early days of the pandemic, doctor's visits were postponed or even canceled. But telehealth allowed many patients to receive care virtually through phone calls or video conferences. Even so, there are some concerns about the quality of care that patients received through telehealth appointments, and even fraudulent billing by some the service providers. Today, we'll find out more from Carolyn Yocom, an expert on health care policy as it relates to Medicaid, the government's program to help low-income Americans. She led work on a new report about Medicaid's coverage of telehealth. Thanks for joining us. [Carolyn Yocom:] It's a pleasure to be here. [Holly Hobbs:] So Carolyn, for our review, we looked at changes in telehealth use among Medicaid users in 5 states. What did we find? [Carolyn Yocom:] We measured that 12 months before the pandemic started and found that, on average, there was about 2.1 million visits that occurred via telehealth in the Medicaid program. In the first year of the pandemic, that grew to 32.5 million visits. So over a tenfold increase in the use of telehealth during the pandemic. [Holly Hobbs:] Were there any limitations to accessing care? For example, was internet access an issue for patients? [Carolyn Yocom:] So there were limitations and the Centers for Medicare and Medicaid Services, the federal agency that looks at Medicaid, they really took a lot of actions to help states be ready to accept telehealth services and to give them more flexibility in how they were delivered and how they were covered. And these flexibilities were things like whether or not you could do telehealth over the phone or whether you needed also a computer and a video. It also allowed to expand the number of providers and the type of providers that gave telehealth. [Holly Hobbs:] And do we know anything about who received telehealth services during the pandemic? [Carolyn Yocom:] We really found that older individuals on the Medicaid program tended to have a fewer percentage of telehealth visits. Men tended to have a higher proportion of telehealth visits than did women. And then urban areas were also more likely, again, on a percentage basis to receive telehealth services. We also tried to look at differences across race and ethnicity. And the data were more limited in this area. But we did not find any discernible pattern between the use of telehealth across different races and ethnicities. [Holly Hobbs:] So it seems like as services moved to a virtual environment, there could be added risks that providers would bill for hours or services that didn't happen, right? What do we know about fraud in this program? [Carolyn Yocom:] Well, we know that fraud is always a risk in health care programs and Medicaid is no exception. And we also know that CMS and the states did try to think about this a little bit and try to look for ways that they could help prevent this from occurring. At the CMS level they looked at things like billing for too many services in 24 hours, something known as impossible hours. States did some of that as well. They also looked at the possible things that could go wrong in a telehealth environment. And these were things such as billing for services that hadn't been received or a provider stealing a beneficiary's ID and then using it for multiple visits. So CMS has opened some investigations trying to look at fraud, and some of the states have as well. In some ways we don't know the extent of fraud potentially going on out there. [Holly Hobbs:] So, you just talked about identifying fraud, but what about preventing it? [Carolyn Yocom:] CMS did take some steps to prevent fraud. The reality is, however, that states really are at the forefront of overseeing fraud risk because once the state has approved program spending, then it has already occurred. So it really is important that the states take a good look at their data and a good look at their information system. {MUSIC} [Holly Hobbs:] So Carolyn just told us that telehealth appointments among Medicaid beneficiaries increased ten-fold during the pandemic in the states we looked at. And that while the Centers for Medicare and Medicaid Services and states had taking steps to prevent fraud, there are still some concerns about the quality of care patients are receiving. So, Carolyn, what should CMS be doing to monitor the quality of telehealth care? [Carolyn Yocom:] Simply put, CMS has to look. We did find that they were measuring telehealth services and non-telehealth services. But, in its quality indicators, as CMS was not separating out which metrics were related to telehealth and which were related to regular health care services. This is important because telehealth occurred because of the public health emergency. But what seems to be happening is people are comfortable with telehealth services and there tends to be more use. So telehealth is likely here to stay and it's going to be important to make sure that those services are provided in a manner that is high quality and helps ensure that beneficiaries safety and well-being. [Holly Hobbs:] And last question, what's the bottom line of this report? [Carolyn Yocom:] The bottom line is that telehealth is a valuable tool that can help beneficiaries safely access care, particularly during emergencies like a pandemic. However, like any tool, we need to assess when it's useful and when it isn't, and what kind of quality services it can provide. And we also need to protect against misuse. There's additional actions that CMS and the states could be taking in all of these scenarios. [Holly Hobbs:] That was GAO's Carolyn Yocom talking about our new report on how telehealth has been used during the pandemic. Thanks for your time, Carolyn. [Carolyn Yocom:] Sure. Glad to help. [Holly Hobbs:] And thank you for listening to The Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts, Spotify or wherever you listen and make sure to leave a rating and review to let others know about the work we're doing. For more from the congressional watchdog, the U.S. Government Accountability Office, visit us at GAO.gov.