OIG Highlights Medicare RPM Billing Risks in 2025 Report
The US Department of Health and Human Services Office of Inspector General (OIG) released a report on August 25, 2025, analyzing Medicare billing practices for remote patient monitoring (RPM) services. The report comes amid a surge in Medicare payments for RPM, which services nearly one million beneficiaries in 2024, and highlights concerns about potential fraud, waste, and abuse risks in this growing segment. As RPM involves using digital technologies to remotely collect and transmit patient physiological data for assessment, OIG underscores the need for rigorous compliance with existing CMS regulations.
Since CMS expanded Medicare payments for RPM in 2019, services covered have included monitoring physiological metrics like blood pressure and blood sugar through devices transmitting data remotely to healthcare providers. OIG's review focuses on specific CPT codes related to remote physiological monitoring. Previous OIG initiatives, including alerts and prior reports, have flagged issues such as direct-to-consumer marketing targeting Medicare beneficiaries and insufficient provider-patient relationships, which could facilitate improper billing or fraud.
The August 2025 report follows OIG's ongoing scrutiny of RPM, including a 2024 recommendation for CMS to enhance oversight mechanisms. Despite CMS's proposed CPT code updates for 2026, OIG notes CMS did not adjust guidance or impose new requirements responding to past recommendations. OIG continues to advocate for stronger CMS supervision to mitigate fraud risks, particularly given the observed billing patterns of high patient counts without prior engagements and multiple device billings per patient within a month.
Providers and digital health vendors are advised to align their remote monitoring programs with CMS regulations and address highlighted compliance risks. The report also signals heightened likelihood of audits from Medicare contractors using data analytics to identify suspect billing practices. OIG's maintained emphasis on RPM services signals potential forthcoming regulatory changes or additional restrictions to safeguard program integrity.
Overall, this report underscores the expanding role of RPM within Medicare, the regulatory focus on safeguarding these services against abuse, and the evolving compliance landscape facing providers. Stakeholders should monitor OIG and CMS updates closely to adjust policies and procedures accordingly, ensuring RPM services meet federal standards while navigating an increasingly complex oversight environment.