The Office of Inspector General (OIG) rehashed its investigatory focus on two areas of Part B billing — remote patient monitoring (RPM) services and skin substitutes — in its
Semiannual Report to Congress issued Jan. 21.
In a review period covering the six months from April to September 2025, the report highlights "potential fraud" concerning the services and comes as a warning to providers billing for them.
CMS addressed skin substitutes in the final 2026 Medicare physician fee schedule,
deciding to pay a flat rate for 19 HCPCS codes associated with CPT graft application codes ranging from
15271 to
15278. That coverage decision arrived after the OIG found a 640% increase in Part B billing on skin substitute products over a two-year period.
The RPM services come under the scrutiny of the OIG after the agency noted payments exceeding $500 million in 2024, with more than 1 million Medicare beneficiaries on the receiving end of RPM in the same year. RPM spending grew from $15 million in 2019 to $536 million in 2024 across Medicare and Medicare Advantage spending, with traditional Medicare accounting for the bulk of fees.
"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 states. "As such, they signal a need for further scrutiny."
Practices should keep an eye on RPM billing and ensure documentation is up to standards to avoid getting caught in an OIG investigation. As the agency states: "OIG developed several measures to monitor billing for RPM, such as 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 a single enrollee."
Get timely news, expert insights and more — subscribe to
Part B News today.