Policy & oversight
OIG Found About 2.3 Million Dollars in Medicare Telehealth Billing Violations That CMS Safeguards Did Not Catch
A federal audit found that Medicare paid for virtual check-ins and e-visits that violated billing timing rules because CMS and its contractors lacked automated detection tools.
By the Goodsurance editorial teamSeptember 21, 2026
The Department of Health and Human Services Office of Inspector General published an audit finding that Medicare made approximately 2.3 million dollars in potentially improper payments for two categories of telehealth services, virtual check-ins and e-visits, because the Centers for Medicare and Medicaid Services lacked automated safeguards to flag noncompliant billing.
Virtual check-ins allow a patient to briefly consult a provider by phone or video before deciding whether to schedule a traditional visit. E-visits are written online communications handled through a patient portal. Both services carry Medicare billing rules designed to prevent duplicate payment when they occur too close in time to a standard in-office or telehealth evaluation and management visit.
Medicare paid about 2.3 million dollars for telehealth visits that broke billing timing rules because CMS lacked automated safeguards, a federal watchdog found.
The audit found approximately 1.96 million dollars in potential improper payments tied to 173,287 virtual check-in claims billed within a prohibited window: either within 7 days after or 24 hours before a standard evaluation and management visit with the same diagnosis code for the same patient. An additional 298,200 dollars in potentially improper e-visit payments covered 10,237 claims billed within 7 days of another e-visit for the same patient with the same diagnosis code.
The OIG attributed the problem to the absence of automated edits in CMS billing systems and to insufficient provider education on the billing requirements. OIG made three recommendations: add system edits to catch prohibited billing patterns, clarify the procedure code descriptions used to bill these services, and expand provider education. CMS agreed with the first and third recommendations and did not concur with the second.
In plain words
Medicare paid for some telehealth visits that it should not have. A federal watchdog found about 2.3 million dollars in improper payments.
Two types of short telehealth visits are at issue. One is called a virtual check-in, where a patient calls or video chats with a provider before deciding to come in. The other is an e-visit, which is a written message through a patient portal. Both have billing rules. A provider cannot bill Medicare for one of these visits if it is too close in time to a regular doctor visit for the same health problem.
The watchdog found that Medicare did not have computer tools in place to catch these billing violations. So improper payments slipped through. The watchdog told CMS to add those tools and explain the rules better to doctors. CMS agreed to do two of the three things asked.
Understand the basics first
Source: OIG
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