After the violations were discovered, Geisinger Community Health Services told the United States Attorney's Office.
Geisinger Community Health Services will pay the federal government $18.5 million to resolve self-disclosed violations of Medicare billing rules for hospice and home-based care, the Department of Justice announced.
According to the voluntary disclosures, between January 2012 and December 2017, Danville, Pennsylvania-based GCHS affiliates submitted claims to Medicare for hospice and home health services that violated Medicare rules and regulations regarding physician certifications of terminal illness, patient elections of hospice care, and physician face-to-face encounters with home health patients, DOJ said.
After the violations were discovered, GCHS took corrective action and disclosed the matter to the United States Attorney’s Office.
"The $18 million payment in this matter reflects the priority healthcare providers should place on making sure they closely follow all Medicare rules and regulations," Bruce D. Brandler, acting U.S. Attorney for the Middle District of Pennsylvania, said in a media release.
"Healthcare fraud remains a focus of the Department of Justice and the Affirmative Civil Enforcement Unit of the United States Attorney's Office. I commend GCHS for taking this seriously, voluntarily disclosing these issues to our office and working to address the problems that led to these violations," he said.
GCHS responds
GCHS issued the following statement:
"As part of a routine self-audit, Geisinger uncovered billing deficiencies related to home health and hospice services from 2012 to 2017. We promptly took corrective action, notified the federal government and cooperated fully with the government leading up to this settlement. Since uncovering these deficiencies, we have conducted follow-up audits that have shown 100 percent compliance, and we do not anticipate any further billing deficiencies related to these services."
The state executives were told that frail patients have come to rely on remote access with their specialist providers, many of whom reside out of state.
More than 230 telehealth stakeholders sent a letter to the nation's 50 governors urging them to keep in place licensure flexibilities enacted at the start of the pandemic for the duration of the federal public health emergency.
"Over the last few months, many states have allowed COVID-19 emergency declarations to expire and the licensure flexibilities to expire with it, despite the ongoing pandemic and surge in cases due to the Delta variant," said the letter, coordinated by the Alliance for Connected Care, the ALS Association, and the National Organization for Rare Disorders.
"This has been extremely detrimental and disruptive to necessary and ongoing patient care," the letter said. "Healthcare providers have had to scramble to notify thousands of out-of-state patients that their telehealth appointments were no longer possible, and that they would have to drive across state borders to keep their appointments."
Among the flexibilities in the March 2020 1135 waiver put forward by the Centers for Medicare & Medicaid Services, states were allowed to waive licensing requirements so that remote providers could offer patient care across state lines. In addition, eligible payments for telehealth services were expanded to include hospital, physician office, and patient home visits, and a range of providers were allowed to bill for telehealth, including nurse practitioners, clinical psychologists, and licensed clinical social workers. Providers were also given the flexibility to reduce or waive cost-sharing for telehealth visits paid for by federal healthcare programs.
The stakeholders told the governors that many patients have come to rely on telehealth access to see specialists in another state, "made possible by licensure flexibilities enacted at the start of the pandemic, so as not to risk exposure to the virus and to maintain continuity of care through virtual options."
"These patients are now faced with canceling these vital appointments or risking an in-person visit and thus exposure to COVID-19," the letter said.
Krista Drobac, executive director of the Alliance for Connected Care, said government and stakeholdders "must build on the lessons learned from the pandemic and ensure patients can access care from their providers regardless of where they live, especially as the pandemic continues."
"Patients and their families seek care across state lines for many reasons," she said, "and the licensure flexibilities put in place throughout the pandemic have been critical for expanding patient access to care, improving care coordination and continuity of care, and addressing workforce shortages. State governors must act to ensure these flexibilities continue and consider solutions to address the ongoing needs of patients both during the pandemic and in the future."
In October, telehealth stakeholders asked the Biden Administration to provide guidance on the anticipated end of the PHE while also calling for the extension of the PHE and its telehealth provisions through the end of 2022.
In a letter to Health and Human Services Secretary Xavier Becerra, American Telemedicine Association CEO Ann Mond Johnson said the PHE created "flexibilities that have allowed clinicians across the country to provide all Americans high-quality virtual care at a time of great need."
USDA also invests $50 million to improve access to telemedicine, distance learning for 7.6 million rural Americans.
The U.S. Department of Agriculture says it will begin accepting applications for up to $1.15 billion and loans and grants to expand broadband in rural areas.
To be eligible for the ReConnect Program – part of President Joe Biden's Build Back Better Agenda -- the USDA said applicant must serve an area without broadband service at speeds of 100 megabits per second and 20 Mbps, and commit to building facilities capable of providing broadband service at speeds of 100 Mbps to every location in its proposed service area.
"For too long, the 'digital divide' has left too many people living in rural communities behind: unable to compete in the global economy and unable to access the services and resources that all Americans need," USDA Secretary Tom Vilsack said in a media release.
"Rural people, businesses and communities must have affordable, reliable, high-speed internet so they can fully participate in modern society and the modern economy, Vilsack said.
"As we build back better than we were before, the actions… will go a long way toward ensuring that people who live or work in rural areas are able to tap into the benefits of broadband, including access to specialized health care, educational opportunities and the global marketplace."
Funding awards will priorititize projects that serve low-density rural areas with locations lacking internet access services at speeds of at least 25 Mbps and 3 Mbps.
USDA will also consider the economic needs of the community; affordable service options; commitments to strong labor standards; and whether a project is serving tribal lands or is submitted by a local government, Tribal Government, non-profit or cooperative.
USDA said it has simplified the application process and expanded the program, offering 100% grants for certain projects on tribal lands and in socially vulnerable communities.
American Telemedicine Association CEO Ann Mond Johnson says the PHE created "flexibilities that have allowed clinicians across the country to provide all Americans high-quality virtual care at a time of great need."
Telehealth stakeholders are asking the Biden Administration to provide guidance on the anticipated end of the COVID-19 Public Health Emergency while also calling for the extension of the PHE and its telehealth provisions through the end of 2022.
In a letter to Health and Human Services Secretary Xavier Becerra, American Telemedicine Association CEO Ann Mond Johnson said the PHE created "flexibilities that have allowed clinicians across the country to provide all Americans high-quality virtual care at a time of great need."
"Patients and providers know the 'telehealth cliff' is coming with the end of the PHE should Congress fail to act in time," Mond Johnson said. "However, a significant amount of uncertainty surrounds the question of when the PHE will actually expire,"
"We recognize there are many unknowns related to the trajectory of the COVID-19 pandemic over the next 12 to 24 months. However, we implore Secretary Becerra to provide as much predictability and certainty as possible to ensure adequate warning before patients are pushed over this looming cliff," she said.
Becerra this month extended by 90 days the PHE, effective October 18 through January 16, 2022.
Mond Johnson noted that in January 2021 the Biden administration promised governors across the nation that it would provide predictability and stability during the PHE.
"This was a simple action but proved to be hugely beneficial to state and local leaders, federal policymakers, providers, and patients who all relied on a sense of certainty that PHE policies—including those for telehealth—would not be taken away without warning," Mond Johnson said.
The consumer-focused genealogy researcher says the acquisition will advance its "vision of individualized primary care that empowers consumers to live healthier lives."
Under the deal, the purchase price is $400 million, of which 25% will be paid in cash and 75% in shares of 23andMe Class A Common Stock. The acquisition is expected to close by December.
Paul Johnson, CEO and co-Founder of Lemonaid Health, will be the general manager of the 23andMe consumer business and will continue to run Lemonaid Health.
"23andMe's mission-driven focus on empowering and transforming the healthcare experience is perfectly aligned with Lemonaid Health's founding principle to improve access to quality healthcare," Johnson said.
Ian Van Every, managing director, U.K. and co-founder of Lemonaid Health, will manage operations in the U.K.
Anne Wojcicki, CEO and co-founder of 23andMe, said that, with the addition of Lemonaid Health's clinical and pharmacy services offerings to her company's consumer business, "we are taking an important step in transforming the traditional primary care experience and making personalized healthcare a reality."
"By starting with genetics as the foundation, we will give patients and healthcare providers better information about health risks and treatments, opening up the door to prevent as well as better manage disease," Wojcicki said. "Lemonaid Health's focus on the patient and its philosophy of delivering individualized care fits perfectly with our mission of empowering people to take control of their health."
The program launches in January 2022 and will be available to all Cigna customers enrolled in employer-sponsored plans.
Cigna Health Plan's Evernorth subsidiary announced Tuesday that it will leverage its recently acquired MDLIVE telehealth platform to expand virtual care to "millions of customers."
The clinical services offered will include digital-first primary, dermatology, behavioral and urgent care. In addition, MDLIVE physicians will join Cigna's other clinicians, with access to patient health records, to coordinate the care, the company said.
The program launches in January 2022 and will be available to all Cigna customers enrolled in employer-sponsored plans.
"With MDLIVE now part of Evernorth, we've fast-tracked our ability to offer a broader suite of differentiated, future-state care solutions that make the patient experience easier and more convenient," Evernorth President Eric Palmer said in a media release.
"Today's announcement represents a significant step forward for millions of health plan customers who will gain on-demand access to a wider range of highly-specialized, in-network health care professionals."
Heather Dlugolenski, senior vice president, solutions, Cigna said the expansion builds on last year's launch with MDLIVE of a virtual wellness visit program and extends primary care access to the more than 75% of Cigna customers in 2020 who used MDLIVE but did not have a regular primary care doctor.
"Not only will this give more people an additional entry point to the healthcare system, but patients will be able to build lasting relationships with their preferred MDLIVE provider just as they would in a traditional office setting," Dlugolenski said.
For some employers, Cigna is also offering virtual-first health plans that include $0 copays with MDLIVE primary care providers, chronic disease management and care navigation, with no referrals needed for in-person visits with in-network health care providers.
The Cigna announcement comes one week after UnitedHealthcare unveiled a collaborative with Optum to roll out a "virtual-first health plan" in nine markets across the nation. Minnetonka, Minnesota-based United is touting NavigateNOW as "a simpler, more convenient experience at approximately 15% less premium cost than traditional benefit plans."
The Volunteer State is also being asked to provide the paperwork or refund another $370 million for improperly documented behavioral health services.
Federal auditors this week recommended that Tennessee's Medicaid program refund to the federal government $397 million in uncompensated care overpayments, and refund or provide documentation justifying another $370 million paid for behavioral health services.
TennCare Director Stephen Smith said he "strongly objects" to the findings put forward by the Department of Health and Human Services' Office of the Inspector General, calling the report "inappropriate and unreasonable."
OIG auditors examined Tennessee's $2 billion certified public expenditures for uncompensated care at public hospitals for TennCare enrollees from 2009-14. For state fiscal years 2010-13, the report found that Tennessee each year claimed the same amount -- $373.8 million – which auditors said shows that the state didn't calculate specific estimates of the CPEs for each of those years, as required.
The audit said that Tennessee did not comply with federal requirements for claiming CPEs for public hospital unreimbursed costs.
"Of the $2 billion in CPEs that Tennessee claimed during our audit period, $909.4 million was allowable and supported," OIG said. "However, the remaining $1.1 billion ($767.5 million federal share) exceeded the amount allowed. This amount included $482.1 million ($337.5 million federal share) of excess CPEs that Tennessee claimed but did not return after calculating actual CPEs."
OIG said Tennessee calculated another $609.4 million ($430 million federal share) above the allowable amount, which included $522.3 million ($370.1 million federal) of unsupported net costs of caring for uninsured behavioral health patients, $53.6 million ($37.9 million federal) of unallowable net costs of caring for TennCare behavioral health patients ages 21-64, and $33.5 million ($22 million federal) of overstated costs because of faulty math.
OIG recommended that Tennessee: Refund $397.4 million in overpayments for CPEs that exceeded the allowable amount; provide documentation or a refund for $370 million in improperly documented money for behavioral healthcare; and establish procedures to ensure compliance with federal requirements.
Tennessee 'Strongly Obects'
In a response included with the audit, TennCare Director Smith said the state "strongly objects" to OIG's methodology that relies on "an audit process that dates back 12 years (and) is fundamentally flawed and places the state in the impossible position of having to refute findings without key documents or historical knowledge of key agreements – both formal and informal - from individuals responsible for decisions and actions from both the state agency and the federal government."
In addition, Smith said TennCare has "provided completely acceptable and auditable documentation" that adheres to federal guidelines for the $370 million in claims for behavioral health services.
"If OIG applied this clear federal guidance and the language of the demonstration as intended by CMS, the total findings would immediately be reduced by more than half," Smith said.
One-third of rural older adults had at least one virtual visit in 2020, compared with nearly half of seniors in suburban and urban areas.
About 16% of doctor's visits by seniors were done remotely, either by phone or online over the past two years, but the rural elderly appear to be behind the curve, according to a new analysis of telehealth visits billed to Medicare.
The total number of virtual visits – the kind focused on evaluating a medical condition or symptom and making a plan for managing it – didn't rise from 2019 to 2020, the analysis shows, despite concerns that widespread access to telehealth because of the COVID-19 pandemic would lead to an increase in the total number of such visits.
However, the data showed that one-third of rural older adults had at least one virtual visit in 2020, compared with nearly half of seniors in suburban and urban areas. Researchers from the University of Michigan say the data suggest that policymakers need to find a way to improve telehealth access among the rural elderly.
"Before the pandemic, Medicare's telehealth provisions focused mainly on rural areas, to increase access to specialists through virtual visits originating from their local physician's office, but uptake was low," said study lead author Chad Ellimoottil, MD, an assistant professor of urology at Michigan Medicine.
"In the pandemic era, coverage for telehealth has led to a steady percentage of evaluation and management appointments being conducted virtually. For the most part, these visits have been a substitute for in-person care," he said.
At the height of the first pandemic surge in April 2020, about half of Medicare participants' appointments to evaluate a medical concern and get a treatment recommendation took place online or over the phone. That declined to between 13.5% and 18.3% for the rest of 2020, the data showed.
However, the overall number of evaluation and management appointments didn't rise past the median number of such visits in 2019. In fact, seniors had fewer such appointments for all of 2020, which the researchers said suggests that telehealth visits are being used as a substitute for in-person care, not an add-on, and that some adults are avoiding care.
NavigateNOW is being touted as "a simpler, more convenient experience at approximately 15% less premium cost than traditional benefit plans."
UnitedHealthcare is collaborating with Optum to roll out a "virtual-first health plan" in nine markets across the nation that the payer says will provide beneficiaries with greater access to remote and in-person customized care.
Minnetonka, Minnesota-based United is touting NavigateNOW as "a simpler, more convenient experience at approximately 15% less premium cost than traditional benefit plans."
Enrollees in the new plan will have access to 24/7 care from Optum providers for primary, urgent and behavioral healthcare services, backed by UnitedHealthcare's national network of providers.
They will pay $0 for virtual and in-person primary care and behavioral health visits, virtual urgent care and most generic medications, with unlimited chat, online scheduling and on-demand, same-day appointments.
They will also have access to a wearable device well-being program that incentivizes them to earn more than $1,000 per year by meeting daily activity targets, such as for walking, cycling, swimming and strength training.
Rhonda Randall, MD, CMO, UnitedHealthcare Employer & Individual, said the collaboration with Optum provides "a more integrated and coordinated healthcare system that uses technology and personal support to help encourage whole-person health, which may help prevent and detect disease before it starts."
"UnitedHealthcare and Optum will continue working together to modernize our approach to health benefits and care delivery, using technology and data to help make it more convenient for our members to access various types of medical care to support their physical and mental well-being," Randall said
NavigateNOW is offered to employers in Little Rock, Ark.; Fort Myers, Fla.; Pittsburgh; Springfield, Mass.; Minneapolis/St. Paul, Minn.; Richmond, Va.; Indianapolis; Dallas; and Houston.
The program matches enrollees' health profiles and existing medical conditions with personalized care teams led by a dedicated primary care provider who will coordinate virtual and in-person visits with Optum providers and other providers as needed.
For instance, during virtual primary care appointments, Optum providers will have the ability to connect the UnitedHealthcare member with behavioral health services within the virtual platform as needed to facilitate virtual or in-person behavioral health appointments, including therapy, medication management and additional care coordination with other health services.
Kristi Henderson, CEO, Optum Virtual Care, says the new product is a response to "patients (who) want more options for getting care that is convenient for them and their lives."
"Our work with UnitedHealthcare is designed to help make it simpler for patients and members to interact with their care providers by bringing together our digital resources and national clinical footprint to provide a more seamless, connected experience," she said.
The care-at-home platform specializes in remote patient monitoring and telehealth.
Best Buy announced Tuesday that it will buy Current Health, a Scotland-based patient monitoring and telehealth platform, further expanding the retailer's stake in the healthcare sector.
Terms of the pending sale were not disclosed.
Best Buy says that the increasing reliance upon the consumer-friendly technology that the Minnesota-based retailer sells will play a critical role in the expansion of telehealth.
"The future of consumer technology is directly connected to the future of healthcare," Deborah Di Sanzo, president of Best Buy Health, said in a media release.
"We have the distinct expertise in helping customers make technology work for them directly in their homes and by combining Current Health's remote care management platform with our existing health products and services, we can create a holistic care ecosystem that shows up for someone across all of their healthcare needs," Di Sanzo said.
The deal marks another incursion into the healthcare space by Best Buy, which in August 2018 acquired seniors-focused emergency response provider GreatCall in an $800 million deal, and in 2019 acquired Critical Signals Technologies, a Michigan-based remote monitoring service.
Leveraging clinical algorithms that can be tailored to the individual patient, Current Health claims its technology can identify when a patient needs clinical attention, allowing providers to manage care remotely or coordinate in-home care using its integrated service partners.
"Best Buy has unparalleled physical reach, world-class supply chain logistics, and trusted support services–allowing us to provide a high-touch consumer experience, at scale," said Current Health CEO Christopher McCann.
