Payments for remote physiologic monitoring (RPM) services have skyrocketed under Medicare, surpassing $535 million in 2024. That's up from just $15 million five years earlier. As services spike, the HHS Office of Inspector General (OIG) is sending out a warning: we're keeping an eye on you.
In a data snapshot released in August, the OIG found that more than 1 million Medicare enrollees received some form of RPM services in 2024. More than 10,300 distinct medical practices billed traditional fee-for-service Medicare or Medicare Advantage for at least one RPM offering. That's according to the OIG, which examined claims from CY 2024, looking specifically at CPT codes 99091, 99453, 99454, 99457 and 99458.
In an effort to spot fraudulent claims, the OIG identified several measures to track utilization, including "billing for a high proportion of enrollees who have no prior history with the medical practice" and "billing for multiple monitoring devices a month for an enrollee." The former is important because medical groups must have an established relationship with a patient prior to offering an RPM service, while the latter measure might indicate double billing.
Of the more than 10,000 medical practices that reported at least some RPM services, the OIG found that about 4,600 practices "routinely billed" Medicare for the services. On average, these frequent RPM utilizers provided services to 70 enrollees per year and added five new enrollees per month.
However, some medical practices stood out. More than 30 practices that the OIG reviewed saw at least a 150% growth rate in a single month, and one medical practice added more than 3,400 enrollees in a given month. These outliers are now officially on the OIG's radar, and other groups who are expanding RPM services should take note of the utilization patterns that the OIG is monitoring.
"While significant increases in billing may represent legitimate growth in a practice’s uptake of remote patient monitoring, these types of spikes in billing have been a marker of fraud in other Medicare services," the OIG said in the report. "As such, they signal a need for further scrutiny."
The requirement of having an established relationship with a patient prior to launching an RPM arrangement appears to be a primary focus for the OIG.
The agency's review found that "45 medical practices ... did not have a prior medical relationship with more than 80 percent of the patients for whom they billed remote patient monitoring in 2024. In one example, a medical practice lacked a prior relationship with more than 30,000 enrollees. Further review of these medical practices is warranted."
The OIG expects RPM services to fluorish in the coming years, saying they have "the potential to greatly expand in the future." Practices expanding their offerings should monitor the OIG's warning shot.
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