Remote patient monitoring (RPM) vendors are courting nursing facilities with free devices, per-resident monthly fees, and revenue-sharing arrangements tied to resident enrollment. A nursing facility is a referral source: it decides which residents are offered monitoring and which vendor supplies it. Under the federal Anti-Kickback Statute, remuneration that flows to a referral source to induce that choice is a felony, regardless of its label. OIG and CMS have each acted on closely related remote monitoring arrangements in 2025 and 2026.
What the Anti-Kickback Statute Prohibits
The Anti-Kickback Statute, 42 U.S.C. 1320a-7b(b), makes it a felony to knowingly and willfully offer, pay, solicit, or receive remuneration to induce a referral, or to induce the purchase, lease, order, or recommendation of an item or service reimbursable under a federal health care program. A violation carries a fine of up to $100,000 and up to ten years in prison, plus exclusion from Medicare and Medicaid. Remuneration is not limited to cash. Free equipment, a waived setup fee, and a share of collections can all qualify.
Why Facility-Directed Fees and Free Equipment Draw Scrutiny
OIG has flagged free items and services furnished to a referral source as an Anti-Kickback Statute risk. In a June 2025 unfavorable advisory opinion, OIG declined to clear a device manufacturer's proposal to pay for compliance screening services on behalf of the hospitals and surgery centers that purchase its products, finding the arrangement could function as prohibited remuneration regardless of its administrative framing. The same reasoning reaches a nursing facility that receives a vendor's monitoring devices at no charge, a fee for each resident enrolled, or a share of the vendor's Medicare collections: the benefit runs to the party that controls which residents get monitored and by which vendor.
A nursing facility that receives free monitoring equipment, a per-resident fee, or a share of a vendor's Medicare collections is receiving remuneration from a referral source, not a courtesy.
No Safe Harbor Covers a Free Device or a Revenue Share
The equipment rental and personal services safe harbors at 42 C.F.R. 1001.952(c) and (d) both require that any payment be set in advance at fair market value, run from the facility to the vendor rather than the reverse, and never take the volume or value of referrals into account. A vendor that waives the facility's cost, pays it per resident, or shares collections with it does not fit either structure. Absent a safe harbor, OIG and the Department of Justice assess the arrangement on the full set of facts, including whether the payment moves with referral volume.
Regulators Are Already Acting on This Fact Pattern
The enforcement record already includes an RPM vendor-referral case. In January 2025, LiveCare Inc. agreed to pay up to $4.9 million to resolve allegations it paid a marketing company for Medicare beneficiary referrals to its remote monitoring program, pursued under both the Anti-Kickback Statute and the False Claims Act. Separately, a CMS proposed rule published in July 2026 for the 2027 Physician Fee Schedule would bar Medicare from paying for RPM services unless the clinical staff performing them are direct employees of the billing practice. The same rulemaking cites an OIG finding that 43 percent of RPM enrollees were not receiving all three required service components, consistent with the same telehealth enforcement pattern regulators have applied elsewhere. A facility that cannot show its vendor relationship was independent of referral volume also faces recoupment exposure on every RPM claim the arrangement touched.
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 nursing facilities and RPM vendors promptly retain experienced healthcare defense counsel upon receiving a subpoena, audit notice, OIG inquiry, or other government inquiry tied to a remote patient monitoring vendor arrangement. 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 represents physician practices, providers whose patients live in nursing facilities, and the monitoring and billing companies that support them in audits, investigations, and False Claims Act referrals tied to remote patient monitoring arrangements. Our attorneys structure and defend these relationships against the statute and its safe harbors, not against marketing labels. If your facility or vendor arrangement is under review, contact our remote patient monitoring audit defense attorneys for a free, confidential consultation.
