The Department of Health and Human Services Office of Inspector General has published two reports on remote patient monitoring billing within about a year, and together they describe the billing patterns a facility population is most exposed to. The September 2024 report, Additional Oversight of Remote Patient Monitoring in Medicare Is Needed (OEI-02-23-00260), found that about 43% of enrollees who received remote patient monitoring did not receive all three billed components, and that Medicare had no information about who ordered the monitoring for about 44% of enrollees. The August 2025 data snapshot, Billing for Remote Patient Monitoring in Medicare (OEI-02-23-00261), followed with five billing patterns the OIG now uses to flag a practice for scrutiny. Neither report breaks its findings out by site of service, but the patterns they describe, incident-to billing by a supervising provider, no established relationship before monitoring starts, and treatment management that is never billed, map directly onto how remote patient monitoring reaches a nursing facility population.
The September 2024 Findings on Component and Ordering Gaps
The 2024 report analyzed claims from 2019 through 2022. Remote patient monitoring has three components: enrollee education and device setup, device supply, and treatment management. About 28% of enrollees had no claim for education and setup, about 23% had no claim for the device, and 12% never had a claim for treatment management from any provider. Medicare also lacked information about who ordered the monitoring for about 44% of enrollees, and the report flagged incident-to billing, where a supervising provider lists their own identification number for monitoring that staff actually deliver, as a transparency gap. In one case, a single provider billed 23,569 hours of treatment management in a year, a volume the OIG said CMS could not evaluate because it did not know how many individuals delivered the service.
The August 2025 Data Snapshot's Five Billing Patterns
The 2025 data snapshot covers 2024 claims and developed five measures to flag practices for scrutiny. Medicare payments for remote patient monitoring reached $536 million in 2024, a 31-percent increase from 2023, while nearly 1 million enrollees received the service, a 27-percent increase. The OIG identified 45 practices that billed without a prior relationship with more than 80% of their patients, 52 practices where more than 75% of enrollees never had treatment management billed, 34 practices that frequently billed for the same enrollees as two or more other practices, and about 20 practices that billed for two or more monitoring devices per enrollee in the same month, one of them nearly 1,700 times in a year.
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.
Why These Patterns Matter for Long-Term Care Populations
Remote patient monitoring reaches facility populations through arrangements these measures were built to catch. Facility staff often deliver remote patient monitoring to a nursing facility resident under a supervising physician's billing number, the incident-to structure the 2024 report flagged for its lack of transparency. A device or monitoring company operating under a telehealth platform agreement with the facility, rather than the resident's own longstanding physician, may lack the prior relationship the 2025 snapshot treats as a scrutiny trigger. A resident who never receives treatment management because staff cannot complete the required monthly review raises the same question the OIG raised about every practice in that position: whether the monitoring was necessary at all. A program integrity contractor, including a Unified Program Integrity Contractor (UPIC) reviewing a facility's claims against these patterns, can move straight to a recoupment demand, and a device-company kickback arrangement behind the monitoring contract can raise anti-kickback statute exposure as well. A pattern of claims that do not match the service furnished can also raise False Claims Act exposure. A practice evaluating, or being evaluated for, one of these arrangements, including through a practice acquisition, should treat these measures as a diligence checklist before claims are submitted, not after an audit notice arrives.
Health Law Alliance's attorneys have overseen 2,000+ audits and handled 5,000+ matters, with 25+ years of experience.
Why Early Legal Counsel Is Critical
It is critical that healthcare providers promptly retain experienced healthcare defense counsel upon receiving a subpoena, audit notice, investigative request, or other government inquiry. Early legal intervention can protect the provider's rights, ensure appropriate responses to government requests, avoid inadvertent admissions, preserve relevant defenses, and allow counsel to communicate with investigators on the provider's behalf. Delaying legal representation can significantly affect the outcome of a matter and expose the provider to unnecessary risk.
How Health Law Alliance Can Help
Health Law Alliance's remote patient monitoring audit defense attorneys represent physicians, group practices, and facilities nationwide in RPM audits, including matters involving nursing facility populations and incident-to billing arrangements. If your practice has received an audit notice or document request involving remote patient monitoring claims, contact Health Law Alliance's remote patient monitoring audit defense attorneys for a free, confidential consultation.
