Telehealth

Increased telehealth utilization wasn’t linked to more low-value services at primary care clinics, according to a study published in JAMA Network Open.

The research found no association between practices that used high levels of telehealth and most types of low-value care, or services that have no clinical benefit for patients and rack up costs.

The findings could reassure policymakers who have raised concerns that virtual care could increase unnecessary or wasteful services and drive up healthcare spending, the study’s authors wrote.

Telehealth plays a larger role in healthcare delivery in the wake of the COVID-19 pandemic, which pushed clinicians to deliver more care remotely to avoid spreading the virus. 

But regulators, lawmakers and providers are still trying to hash out policy questions surrounding virtual care, like how to ensure quality and protect in-person options — as well as how much to pay for its use. 

Driving up wasteful healthcare spending is another concern for policymakers. One study published in 2022 found some patients with acute conditions were more likely to require an in-person follow-up appointment after a telehealth visit, raising concerns about duplicative care. 

The convenience of telehealth might also drive unnecessary utilization or push providers to prescribe more diagnostic tests, according to the latest JAMA study.

But the new research, which studied data from more than 577,000 Medicare beneficiaries, found no link between telehealth use and low-value care.

The study divided practices based on how much telehealth services they provided in 2022. Researchers then analyzed primary care practices’ rates of low-value services, including CT scans for uncomplicated acute rhinosinusitis and imaging for headaches without complications or nonspecific low back pain. 

Cervical cancer screenings for women over 65 years old and low-value thyroid testing actually decreased among practices with high levels of telehealth use, according to the research. Six other types of low-value services weren’t affected by the amount of virtual care delivered at all.

Use of low-value cervical cancer screenings actually decreased in primary care clinics with high telehealth visits, likely because the pap smear test needs to be conducted in-person anyway, according to the study’s authors.

The reasons for fewer wasteful thyroid screenings were less clear, but virtual care might limit opportunities for patients to undergo lab tests during their visits due to convenience, they added.

More than 200 telehealth and provider organizations are asking the Trump administration to hammer out regulation governing telehealth prescriptions of controlled substances before pandemic-era flexibilities expire at the end of 2025. 

In a letter sent to Terry Cole, the newly confirmed administrator of the Drug Enforcement Administration, the groups urged the administration to ensure a plan is in place by fall 2025 so patients can continue to receive remote prescriptions of controlled substances.

The Biden administration proposed a framework for telehealth prescriptions just before President Joe Biden left office in January, but some industry groups have panned the proposed rule as too onerous for providers.

In the letter, the telehealth advocates pushed the DEA to work directly with experts and other stakeholders on how to craft policy on virtual prescribing — an increasingly urgent concern given the temporary flexibilities are set to lapse. 

“Past efforts which did not fully engage stakeholders and Congress had unintended consequences – such as the creation of massive significant new regulatory burdens on the health care systems,” the groups, which include the American Telemedicine Association and the Alliance for Connected Care, wrote.

Policies around remote controlled substance prescribing have been in limbo for years.

The flexibilities were put in place during the COVID-19 pandemic in a bid to preserve access to care, granting exceptions to a law that typically required clinicians to have an in-person appointment with a patient before prescribing controlled substances.

The policy was originally set to lapse in 2023, but it’s since been extended multiple times. Regulators most recently prolonged the flexibilities through 2025.

Telehealth advocates argue the policy is a significant boost for access to care, allowing people who live in rural areas or communities with few mental health professionals to receive support remotely. 

However, the DEA has said it wants to balance ensuring drugs aren’t dispensed improperly. Some telehealth companies have faced fines or legal action in recent years for allegedly trying to boost prescriptions or prescribe medications even if patients don’t qualify. 

Still, regulators have made some moves toward enacting permanent policy on telehealth prescribing. 

In early 2025, the DEA proposed a regulation that would create special registrations authorizing providers and telehealth companies to prescribe Schedule II to Schedule V drugs, like Adderall and Xanax. 

The proposal also included requirements for clinicians to check state drug monitoring databases before issuing a prescription, as well as limitations on Schedule II prescriptions. Telehealth groups raised concerns about the proposal, arguing the changes would be challenging for providers and could restrict access to care. 

Regulators also finalized a rule that would allow DEA-registered clinicians to prescribe up to an initial six-month supply of buprenorphine, a medication for treating opioid use disorder, via telehealth without first seeing the patient in person.

However, enforcement of that regulation was delayed through the end of the year. 

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By Moss Adams (now Baker Tilly)

After telehealth programs surged into common use during the COVID-19 pandemic, virtual visits continue to thrive to access health care—and so have associated compliance risks along with increasingly stringent regulations.

A string of developments from the Office of Inspector General (OIG)—such as a 2022 telehealth fraud alert and a 2023 tool kit for telehealth integrity—signal intentions of increased audits and focus. Is your program resilient enough to withstand the expected scrutiny ahead?

Brian Conner, a partner at Baker Tilly, sat down with telehealth compliance professional Kim Hodson, a senior manager, to discuss how compliance officers should be evaluating and mitigating their risks.

Background on telehealth

By the second quarter of 2020, 47% of Medicare beneficiaries used telehealth—a large jump from the 7% just months prior. IT and billing leaders had to pivot quickly to expand telehealth programs in response. Many took advantage of Centers for Medicare & Medicaid Services waivers that enabled visits over various virtual mediums. The Office for Civil Rights (OCR) also noted they wouldn’t enforce applicable regulations during the public health emergency (PHE).

Beyond the PHE, a newer challenge has emerged with regulators cracking down on telehealth billing compliance.

Telehealth programs have matured to support a stable utilization rate of between 13% and 20%, depending on the specialty. Leaders have established a rhythm for how those interactions are documented and coded to meet regulations.

Why should health care organizations worry About telehealth billing compliance? And why now?

The OIG has been concerned about telehealth billing since before the pandemic, but it’s become more important since 2020, as the number of telehealth services have increased in amount and complexity, highlighting areas of risk for fraud and abuse.

These risks have become more of a day-to-day concern, though the PHE has been removed. Compliance leaders should be thinking about how to oversee and monitor their telehealth program now that the pandemic crisis and things have stabilized. It’s an opportunity to evaluate your risk profile, especially given expected scrutiny in the years ahead.

What should provider organizations do to identify and mitigate telehealth compliance risks?

Organizations have developed an organization-wide compliance program built on the seven elements of an effective compliance program to reduce fraud, waste, and abuse. One of many resources is the OIG General Compliance Program Guidance released in November 2023.

That framework covers oversight, policies and procedures, education and training, lines of communication, internal audits and monitoring, standards, and issue reporting. Review your compliance work plan to include telehealth in some way.

Consider the telehealth compliance implications and assess your organization’s unique risks and vulnerabilities—at least annually. If you’re not meeting one of these risk areas, you’ll need to plan to address it. The higher the risk, the more quickly it should be addressed.

What are top areas to focus on for telehealth billing compliance?

The risk varies with the health care entity, and with level of internal auditing and monitoring.

Internal auditing and monitoring

One of the most deficient areas is internal auditing and monitoring. During COVID-19, providers were quick to set up telemedicine documentation, but reviewing that documentation fell to the bottom of the priority list as telehealth care delivery itself evolved so rapidly.

Now’s a good time to give it another look—to make sure documentation is complete and that it supports the services that you’re currently billing for, particularly around documentation of time for services. This is important because telehealth compliance may require monitoring of details that traditional visits don’t, such as provider location, patient location, communication channel, and start and stop times.

Perform retrospective audits of telehealth services provided during the PHE. It would be better to identify if there were noncompliant issues before a regulator may come calling to audit.

Policies and procedures

Policies and procedures comprise another high-risk area. Before the PHE, policies and procedures may not have reflected guidance pertinent to telehealth. For example, current compliance plans may not be accounting for digital literacy or accessibility—something that could be essential for telehealth access.

Your organization’s policies and procedures need to reduce your risk. You validate that with a risk assessment. Understand what the risk to the organization is from the context of telehealth medicine and update policies and procedures accordingly. Additionally, have a mechanism to update policies and procedures based on the outcomes of audits or investigations coming in through the fraud, waste, and abuse (FWA) hotline.

What are the stakes? What happens to unmitigated telehealth billing risks?

Risks of noncompliance includes OIG fines, Department of Justice settlements, corporate integrity agreements, patient safety risks, and patient privacy violations and associated fines.

Have you worked on projects where someone was put under a corporate integrity agreement for telehealth noncompliance?

Not yet, but it’s coming.

Again, the biggest risk area we see tends to be documentation. OIG has been more lenient with the PHE, but with the end of flexibilities, they’re going to start enforcing compliance. Showing that you’re putting strategies in place to correct issues can help. It’s always better to be proactive.

Does this only apply to medicare and medicaid?

Yes and no.

The guidance and associated enforcement affect providers who serve Medicare and Medicaid populations. But the guidance established by the OIG is still a good framework, regardless of payer source. And most commercial health plans have a government arm anyway like Medicare Advantage, which means everyone should be paying attention to these practices.

What else Is important to know?

Telehealth isn’t going away. Utilization rates have ebbed and flowed over the past four years, but virtual care is here to stay. Providers need to be thinking about telehealth compliance, and now’s the time to do it as the pandemic dust settles and enforcement actions pick up.

Compliance that evolves

Compliance needs to evolve to account for the increasing prevalence and complexity of virtual encounters.

Brian Conner has practiced public accounting since 1993, providing audit, tax, and consulting services to integrated health systems, hospitals, ancillary providers, mental and convalescent health facilities, and medical groups. He can be reached at [email protected] or (209) 955-6114.

Kim Hodson has over 20 years of experience assisting organizations in meeting key performance indicators while maintaining compliance with applicable laws and regulations. She can be reached at [email protected] or (480) 366-8314

Baker Tilly is a leading assurance, tax and advisory firm that provides a comprehensive range of professional services to businesses and individuals. We protect and enhance our clients’ value through innovation, forward-thinking strategies and a trailblazing mindset. The result is a tailored pathway to success for each of our clients.

Teladoc Health is joining an Amazon marketplace that aims to connect consumers with health benefits programs, the telehealth vendor said.

Now, eligible users can find and enroll in Teladoc’s diabetes, hypertension, pre-diabetes and weight management programs through Amazon’s Benefits Connector.

The program could help drive enrollment in Teladoc’s chronic care offerings, executives said at the J.P. Morgan Healthcare Conference in San Francisco in January 2025. “I wouldn’t count on it bringing revenue for us very quickly, but it is certainly something that we will continue to pursue in terms of growing our chronic care program,” Teladoc CFO Mala Murthy said.

Amazon launched the benefits connector in January 2024, starting with a partnership with chronic condition management company Omada.

The technology and retail giant has since expanded the initiative, previously called Health Condition Programs, to more digital health companies, including behavioral healthcare provider Talkspace, online therapy and mental health firm Rula and digital physical therapy company Hinge Health.

The benefits connector works by matching users with digital health programs and then checking when the benefits are covered through the consumer’s insurance plan or employer. If eligible, users can apply to join the programs.

Surfacing Teladoc’s offerings will help eligible consumers more easily access its chronic care programs, which represent an important growth driver at the telehealth firm, executives said at JPM.

The company has more than one million active enrollees across its chronic condition programs, according to a January 2025 press release. 

“We offer chronic condition management programs extensively, and so we have a lot of people out there that we can recruit and enroll,” Teladoc CEO Chuck Divita said at JPM, adding: “It’s Amazon. They’ve got a great consumer experience, so we're happy to be on the platform and see where it goes.”

Teladoc has focused on cutting costs and restructuring its business. The virtual care firm’s stock price has sunk compared with the heights reached during the COVID-19 pandemic as providers and patients turned to virtual care.

Divita, a former insurance executive, is also relatively new to the role. He took on the top spot at the telehealth vendor in June, months after longtime CEO Jason Gorevic abruptly left the company.

In the third quarter of 2024, Teladoc recorded a $33.3 million net loss on revenue of $640.5 million, compared with a $57.1 million loss on $660.2 million in revenue during the same period last year.

Virtual physical therapy company Hinge Health filed to go public in March 2025, signaling the market for digital health initial public offerings may be starting to open. 

The firm narrowed its losses significantly in 2024, reporting a net loss of $11.9 million compared with $108.1 million in 2023, according to a securities filing. It also posted revenue of $390.4 million in 2024, an increase of more than 33% year over year.

The IPO comes as filings in digital health have slowed to a crawl in recent years. But the market could be poised for improvement in 2025, experts say.

Hinge, a decade-old firm that’s secured hundreds of millions in venture capital investment, offers digital musculoskeletal care and physical therapy, including through an artificial intelligence-backed movement sensor and a wearable device that provides electrical nerve stimulation.

The company largely works with self-insured employers, but Hinge is also starting to offer its services through fully-insured health plans and Medicare Advantage plans, according to a securities filing. 

At the end of last year, Hinge had 2,250 clients and more than 532,000 members, the company said. The firm argues the market for musculoskeletal care is huge — for example, nearly 40% of adults reported lower back pain in 2019, according to the CDC. 

“Our first decade in business has been focused on physical therapy (PT)—with $70B in estimated annual spend in the United States, PT provides a long runway ahead for our business,” Hinge co-founder and CEO Daniel Perez wrote in a letter to investors. “Over the coming years we’ll continue applying technology to automate other aspects of care, with several new products already in development.”

Hinge hasn’t yet determined the price range or the number of shares that will be offered in the IPO, according to a press release. The company plans to list on the New York Stock Exchange under the ticker symbol HNGE.

Hinge’s IPO is one of just a few recent digital health filings. Although the number of firms going public soared in 2021, alongside record-breaking venture capital investment in the sector, the digital health IPO market froze soon after.

Only one company went public via a merger with a special purpose acquisition company in 2022, and zero digital health firms notched a public exit the following year, according to consultancy and VC firm Rock Health. 

However, a couple companies, like healthcare payments firm Waystar and precision medicine company Tempus AI, went public in 2024. More firms are likely considering going public this year, experts say. If newly public firms that make the leap in the first half of the year perform well, the second half of 2025 could have more activity, Neil Patel, head of ventures at startup builder Redesign Health, told Healthcare Dive late last year.

“It can’t just be like a one-day, 30-day, 60-day spike in price. It has to be like sustained over some period of time,” he said. “And so just the question is, what’s enough?”

Mergers and acquisitions should play an “important role” in Teladoc’s future business strategy, the virtual care firm’s CEO said in June 2025. 

“We’re going to make investments not just for the short term, but things that we think are going to start to increase that [total addressable market], start to increase the scope and range of what we can do. And we think that’s the right place to deploy our capital,” CEO Chuck Divita said at the Goldman Sachs Global Healthcare Conference.

The telehealth company has already completed two acquisitions in 2025, scooping up preventive care firm Catapult Health in February and virtual mental health provider UpLift in May. 

Teladoc plans to be balanced on capital spending between investments within the firm — like spending on data and analytics and improving customer engagement with its suite of virtual care products — and external growth, including M&A, CFO Mala Murthy said.

Potential targets for M&A would focus on tuck-ins that could improve patient engagement, buys that would “expand the aperture in terms of services” and international additions, Murthy said. Expanding the firm’s reach in other countries has been a priority for the telehealth vendor.

“It’s always going to be strong strategic rationale, and it has to make sense for us in terms of driving our top-line growth on a sustained basis,” Murthy said. “That’s essentially what we’d be looking for.”

Teladoc has already made acquisitions under Divita’s tenure as CEO, which began in 2024. 

Buying Catapult, which offers a virtual annual exam with an in-home diagnostic kit, should allow Teladoc to catch members’ health conditions early and funnel them toward its other offerings, like chronic condition management programs, executives said.

Meanwhile, the UpLift deal aims to speed the company’s ability to accept insurance coverage for care delivered by its direct-to-consumer mental health segment, BetterHelp. The unit has struggled recently, and its adjusted earnings before interest, taxes, depreciation and amortization was cut in half in the first quarter of 2025.

Cost is one barrier to getting customers to subscribe to the service, an area where accepting insurance could help, management said.