Don't Let Fraud Derail the Future of Remote Patient Monitoring
The recent report from the Department of Health and Human Services’ Office of Inspector General (OIG) has sparked concern and chatter about potential fraud, waste, and abuse in remote physiologic monitoring (RPM) practices. While the report underscores valid points about billing and transparency, we mustn't let fears of fraud overshadow the transformative potential of RPM. Instead, we must focus on enhancing the system to prevent fraud while continuing to provide quality care to patients.
Patient Care Must Come First
At its core, RPM is about improving patient outcomes by providing real-time data to healthcare providers, especially for chronic conditions like hypertension and diabetes. OIG’s report acknowledges that over half a million patients received RPM services in 2022—a tenfold increase from 2019. This growth shows the essential role RPM plays in modern healthcare, particularly as we face staffing shortages and increasing demands on the healthcare system.
RPM isn’t just a convenience; it’s a lifeline for many patients, particularly those with chronic illnesses, who benefit from ongoing monitoring without the need for frequent in-person visits. And it's making strides in improving health equity—something the report itself highlights. Black and Hispanic patients, along with dually eligible Medicare and Medicaid beneficiaries, are receiving RPM services at higher rates than their counterparts. This underscores how RPM can close gaps in care and improve access for underserved communities.
False Information Paints the Wrong Picture
The Alliance for Connected Care raised concerns over the inaccuracies and biased nature of the OIG's report on Remote Patient Monitoring (RPM). The letter requested that the report be retracted or amended due to these inaccuracies:
The report falsely claimed there is no order requirement for RPM. However, the 2021 Physician Fee Schedule explicitly states this requirement.
The report incorrectly stated that RPM devices must be “internet-connected,” while CMS only requires automatic data upload, which can occur via various methods.
The report misstated that patients must submit 16 days of vitals every 30 days to receive RPM services, which CMS clarified as not a requirement for certain billing codes (99457 and 99458).
The report inaccurately suggested RPM services were not used as intended due to incomplete billing of the three service components (device set-up, supply, and treatment management). The letter explained valid reasons providers may not bill for all components.
When we are working off of false information, it’s difficult to grasp the whole picture. Without a clear understanding of the existing practice of remote monitoring, claiming elevated levels of fraud is inaccurate and damaging to healthcare delivery.
Fraud Will Happen—but It Shouldn’t Stop Progress
Fraud is a serious issue, but it is not unique to RPM or telehealth. Healthcare systems around the world have faced fraud in every type of service, from in-person care to drug prescriptions. Does that mean we should slow down or stop innovating in these areas? Absolutely not.
“There is always going to be fraud or the possibility of fraud, we won’t sugar coat that, but we need to lean into these opportunities to learn from and be aware of gaps in regulation, not shut down a system which delivers quality care across the board.”
We must recognize that fraud is inevitable in any large system, especially in one as complex as healthcare. But the answer is not to backpedal on RPM adoption or impose overly restrictive regulations that limit its accessibility. Instead, the focus should be on improving oversight, enhancing transparency, and plugging gaps in the system to mitigate fraud. The OIG’s recommendations on gathering more data and tightening billing codes are valuable—but they must be implemented in a way that doesn’t hinder providers' ability to deliver care.
Learning from Mistakes and Filling the Gaps
Rather than allowing fraud to derail progress, we need to learn from past missteps and strengthen the system. Fraud can be addressed by better tracking, more targeted provider education, and implementing clear billing standards without creating unnecessary barriers to care. It’s encouraging that the OIG supports the continued use of RPM and is focusing on collaboration to achieve better oversight rather than calling for drastic reductions or restrictions.
However, it’s important to note that providers not billing for every RPM service doesn’t necessarily mean those services aren’t being delivered. Just because a provider isn’t billing for device setup or patient education doesn’t mean these crucial steps aren’t happening. Providers, especially those in primary care, often offer education and guidance without charging for it—much like when they discuss treatment plans or medication side effects with patients.
What we should be doing is supporting providers with clear guidelines on what should be billed, while ensuring that the administrative burden of billing doesn’t stifle the very care RPM is designed to enhance.
Balancing Oversight with Innovation
The OIG’s findings—such as the fact that CMS paid over $300 million for RPM services in 2022, up from $15 million in 2019—shouldn’t lead to knee-jerk reactions. In comparison to the overall healthcare spending, these figures are modest, and the benefits that RPM offers far outweigh the potential costs of a few bad actors exploiting the system. Let’s remember the larger picture here: Medicare's improper payments totaled $31 billion in 2022, while RPM reimbursements were just $311 million. The solution lies not in reducing RPM adoption, but in creating smarter policies and safeguards to ensure its continued growth and success.
Quality Care Must Be the Priority
As we continue to expand RPM and other remote monitoring technologies, our focus should remain squarely on improving patient care. Fraud may occur, but it must not be the roadblock that prevents us from embracing technologies that can improve lives, reduce hospital readmissions, and increase access to care, particularly for underserved populations.
Let’s use the insights from OIG’s report not to fear the future, but to build a better, more secure system that balances patient safety, fraud prevention, and the delivery of high-quality care.
In short, we cannot let the risk of fraud overshadow the opportunity RPM presents to revolutionize healthcare. Instead, we must learn from fraud, fill the gaps in oversight, and continue to push forward toward a future where remote monitoring is a vital, accessible component of patient care.
Join us at CTeL’s Virtual Remote Monitoring Summit
We encourage the telehealth and RPM community to come together, share resources and insight, and build upon this community together.
Join us virtually for CTeL's third annual RPM Summit on Friday, November 1, at 12 PM ET. This premier virtual event will focus on the latest advancements in remote patient monitoring, telehealth, and AI technologies. Tailored for legal professionals, healthcare providers, and industry stakeholders, the summit offers valuable insights and interactive discussions with leading experts.
Don’t miss this chance to stay informed in the evolving digital health landscape. This event is free for CTeL members and $149 for non-members. Register today!