Policy & oversight
Federal Auditors Found 2.26 Million Dollars in Potentially Improper Medicare Payments for Virtual Check-Ins and E-Visits
An HHS inspector-general audit released in April 2026 identified 183,000-plus telehealth claims billed in ways that Medicare rules do not allow and urged CMS to add automated payment guardrails to catch the problems before payment goes out.
By the Goodsurance editorial teamJuly 18, 2026
The HHS Office of Inspector General published an audit in April 2026 examining Medicare payments for virtual check-ins and e-visits, two types of brief telehealth contact that expanded significantly after 2020. The audit covered claims from January 2019 through December 2022. Auditors found 183,524 claims totaling approximately 2.26 million dollars that did not meet program billing requirements.
Two patterns accounted for nearly all of the improper payments. In the first, providers billed a virtual check-in within seven days before or after an in-person evaluation-and-management visit for the same diagnosis and same enrollee. Medicare policy treats the check-in as bundled into that face-to-face service when the visits are so close in time, making a separate check-in bill improper. This pattern involved 173,287 claims totaling about 1.96 million dollars. In the second pattern, providers billed two e-visits within seven days for the same condition and enrollee, another combination the rules do not allow. That group involved 10,237 claims totaling about 298,000 dollars.
Auditors flagged 183,000-plus Medicare telehealth check-in claims as potentially improper. The recommended fix: automated system guardrails before payment goes out.
The OIG recommended that CMS develop automated system edits to flag these claim combinations before payment is made, update billing-code descriptions to reduce ambiguity, and provide targeted education to providers and their billing staff. CMS agreed with all three recommendations.
The audit noted that virtual check-in and e-visit codes were new when many of these claims were filed and that billing teams were still learning the rules, suggesting the improper payments often stemmed from misunderstanding rather than intentional fraud.
In plain words
Federal health inspectors checked on a type of short telehealth call called a virtual check-in and a similar online contact called an e-visit. They found about 2.26 million dollars in payments that broke Medicare's billing rules. The most common problem was when a doctor billed for a short call very soon before or after a regular office visit for the same health issue, which is not allowed because the call is considered part of the office visit. The government recommended that Medicare's payment system be updated to automatically catch these billing combinations before payment is sent. Medicare agreed to make those changes.
Understand the basics first
Source: HHS OIG
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