Medicare RPM payments spike spurs HHS-OIG oversight

A new HHS Office of Inspector General, or HHS-OIG, report found that Medicare payments for remote patient monitoring, or RPM, totaled $536 million in 2024, prompting the agency to develop new measures to monitor RPM billing.

The HHS-OIG conducted the review amid rising RPM utilization within the Medicare population and the need for additional oversight. The agency assessed 10,388 medical practices that billed for at least one RPM service in 2024. They then identified the practices that routinely billed for RPM, that is, practices that billed for 10 or more Medicare enrollees and more than 100 RPM services. In total, 4,639 medical practices routinely billed for RPM in 2024.

The report shows that Medicare payments increased 31% from $408 million in 2023 to $536 million in 2024. The number of Medicare enrollees who received RPM grew 27% year-over-year, totaling nearly 1 million in 2024.

Each of the 4,639 medical practices that routinely billed for RPM in 2024 billed for about 70 Medicare patients over the year. Some practices experienced sudden large increases in RPM billing. One practice billed RPM for nearly 3,400 new enrollees in a single month. The report noted that these sudden spikes in billing have been an indicator of fraud for other Medicare services.

On examining RPM billing practices, the HHS-OIG uncovered some instances of fraud, albeit involving a small proportion of practices. For example, the agency found that 45 medical practices did not have the mandated prior medical relationship with more than 80% of patients for whom they billed RPM in 2024.

Additionally, 34 practices frequently billed Medicare for the same enrollees as two or more other practices, and 20 practices often billed for two or more devices per month per enrollee.

These billing patterns signaled a need for heightened scrutiny, leading HHA-OIG to identify new measures to monitor RPM billing. These include 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 report comes about a year after HHS-OIG released another report outlining the significant increase in RPM utilization from 2019 onwards. The report showed a little over 570,000 Medicare enrollees received RPM in 2022, up from 55,000 in 2019. Medicare payments for RPM soared from $15 million in 2019 to $300 million in 2022.

However, the report revealed several gaps in RPM oversight, including the fact that CMS lacked the necessary information about the types of health data collected and the types of devices used.

HHS-OIG made several recommendations to strengthen RPM oversight, including that information about the ordering provider be included on claims and encounter data.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.