Tag: COVID-19

COVID-19 Tests: Who’s Paying?

The COVID-19 pandemic was a time of turmoil across the nation. During the course of the public health emergency, one unlikely source of controversy: how to provide and pay for COVID-19 tests for uninsured individuals.

From February 20, 2020 to June 23, 2022, 912.77 million COVID-19 tests were administered in the United States alone. Over the course of the pandemic, the federal government sent many of these tests to American households for free. Private insurers covered additional tests. However, there has been controversy over payment and administration of these tests, including a civil fraud suit against providers and an ongoing fight in the United States Court of Federal Claims over who is responsible for paying for the tests that have already been administered.

During the course of the pandemic, the federal government introduced a free COVID-19 test distribution program. The program allowed each U.S. household to order four free at-home COVID tests shipped for free to the consumer via USPS. However, the government website stopped accepting orders March 10, 2025. Some insurers still cover the cost of at-home tests, but they may require a finding of medical necessity. It is now unclear how individuals can seek payment assistance or free tests.

In addition to the test distribution program, the federal government reimbursed claims under a claims reimbursement program for COVID-19 test administration. The government reimbursed claims for healthcare providers and facilities that tested individuals without insurance. However, the program has received its fair share of problematic billing. In June 2024, The U.S. Attorney General filed a civil fraud suit on behalf of the Department of Health and Human Services (HHS) against LabQ for fraudulently billing the federal government for COVID-19 tests. The lab submitted claims for COVID-19 testing where the testing had or would be reimbursed by another source or had been provided to someone with healthcare coverage.

In other cases, the federal government is being accused of failure to reimburse testing. On October 17, LabQ Clinical Diagnostics LLC, Dart Medical Laboratory Inc., and Community Mobile Testing Inc. filed a breach of contract claim against the U.S. government alleging they failed to reimburse $543 million worth of COVID-19 tests on uninsured individuals in New York City. They also filed claims for breach of the Coronavirus Aid, Relief, and Economic Security Act (CARES) Act and other pandemic-era statutes designed to provide relief. The CARES Act, signed into law March 27, 2020, was passed to provide $2 trillion in economic relief and established the Coronavirus Relief Fund to provide $150 billion of direct assistance to states and local governments. The providers submitted claims through a portal established by the program, and the U.S. Department of Health and Human Services states it would reimburse generally at 100% of the eligible Medicare rates for eligible tests. The complaint alleges a premature depletion of funds and termination of the program before plaintiffs were reimbursed.

The payment saga of the COVID-19 pandemic and the resulting lack of clarity in whether providers and hospitals will get tests covered is ongoing. It is one more result of the chaos that occurred across the globe. The United States’ disproportionately high death toll demonstrates that it is critical that better response plans to public health emergencies of this scale are developed and implemented.

The Telehealth Cliff: Implications of Expiring COVID-19 Waivers

During the COVID-19 public health emergency, the U.S. government enacted a series of telehealth waivers that significantly expanded access to remote healthcare services. These changes were designed to address barriers to care during a time when in-person medical visits carried heightened risks of infection. By relaxing long-standing restrictions and broadening the scope of telehealth, policymakers ensured that millions of patients could continue receiving essential medical care. However, because many of these waivers were temporary, the nation does face a policy crossroad as expiration deadlines approach.

Prior to the pandemic, telehealth under Medicare was restricted by geographic and originating site limitations. Patients typically had to be in a rural area and physically present at a medical facility to access telehealth services. The COVID-19 era waivers removed these restrictions, allowing patients to receive telehealth services from the comfort of their own homes and in any location. This shift significantly expanded access, particularly for vulnerable populations, including the elderly, individuals with mobility challenges, and those living in underserved areas.

The waivers also expanded the scope of providers eligible to deliver telehealth services. Physical therapists, occupational therapists, speech-language pathologists, and audiologists were temporarily authorized to bill for telehealth services. Federally Qualified Health Centers (FWHCs) and Rural Health Clinics (RHC) were permitted to serve as distant site providers, further expanding the pool of available telehealth practitioners. Behavioral health care received significant support as well, with relaxed requirements for in-person visits and broader acceptance of telehealth for mental health treatment.

One of the most transformative flexibilities was the inclusion of audio-only telehealth visits. Recognizing that not all patients had access to reliable broadband or video technology, regulators allowed providers to conduct visits via telephone. This proved particularly valuable for low-income and rural patients, helping to close the care delivery gaps.

Prescribing of controlled substances via telehealth also saw temporary adjustments. The Drug Enforcement Administration (DEA) relaxed requirements for in-person visits before issuing prescriptions, which allowed patients to continue receiving critical medications for conditions such as ADHD, anxiety, and opioid use disorder.

As the public emergency wound down, Congress took steps to extend many of these waivers. The American Relief Act of 2025 extended telehealth flexibilities through March 31, 2025, while the Full-Year Continuing Appropriations and Extensions Act pushed the deadline to September 30, 2025. Yet, unless further action is taken, and right now none has, these waivers are set to expire, which creates what some policy experts call a “telehealth cliff.”

If these waivers expire without replacement, access to telehealth will narrow significantly. Medicare patients may once again be limited to receiving telehealth only in rural areas and from specific originating sites, reducing the ability to access care from home. Audio-only visits would no longer be reimbursed, excluding patients without video technology. Non-physician providers may lose the ability to conduct telehealth visits, shrinking the range of available services. Additionally, the more flexible rules for prescribing controlled substances remotely would tighten, requiring more in-person visits.

Now that the expiration date has passed, critical questions about the future of telehealth remain. Supporters argue that the waivers demonstrated telehealth’s effectiveness and necessity, especially in addressing disparities in access to care. They emphasize that removing these flexibilities would disproportionately harm patients in rural, underserved, and low-income communities. Policymakers have responded by introducing proposals such as the Telehealth Modernization Act, which would extend many of these flexibilities through 2027.

The telehealth waivers enacted during the COVID-19 pandemic represented a historic transformation of the US health care system. They expanded access, reduced barriers, and highlighted the potential of telehealth as a permanent feature of modern care delivery. Yet, now with the expiration day has passed, the nation must decide whether to preserve these gains or return to a more restrictive system. The outcome will shape the accessibility, equity, and effectiveness of healthcare for millions of Americans.