December 13, 2023

This article is an update to “Remote Patient Monitoring” published in the Fall 2023 edition of the Alabama Medicine Magazine. The U.S. Department of Health and Human Services Office of the Inspector General (“OIG”) issued a Consumer Fraud Alert related to Remote Patient Monitoring (“RPM”) on November 21, 2023. This alert provided insight into RPM practices subject to scrutiny by OIG.

OIG indicated that legitimate RPM includes the use of medical devices like scales, glucose monitors, blood pressure cuffs, cardiac rhythm devices, and other like equipment to continuously monitor patients with chronic conditions for medical anomalies within the comfort of the patient’s home. However, there must be a medical necessity for such services for bills submitted for RPM services to withstand enforcement scrutiny from OIG. Accordingly, to minimize the risk of enforcement actions, providers should ensure that the need for such services is present before setting up a patient with an RPM device.

Additionally, OIG indicated that fraudulent use of RPM occurs where billing is submitted for set-up, patient teaching, and monthly monitoring of data and the RPM equipment does not meet the statutory standards. For example, fraudulent RPM billing occurs when bills are submitted for RPM services, but RPM equipment either (i) is not sent to the patient or (ii) is sent, but is not FDA-approved. Providers should be sure that all equipment provided to their patients meets the requisite requirements for FDA approval before submitting bills for RPM services. Additionally, providers should ensure that patients have RPM equipment and appropriately use the equipment to meet coding requirements before billing for any RPM services provided.

When setting up RPM services, OIG has addressed some suspect characteristics of RPM that providers should consider. These characteristics include (i) signing patients up for RPM services through call centers; and (ii) failing to include necessary patient consents for RPM services in patient files. With these characteristics in mind, there are steps that providers can take to lessen the risk of scrutiny from OIG. First, providers should be sure to maintain policies and procedures to ensure that the proper documentation of patient consents is kept in appropriate files. Additionally, as a best practice, providers should only set up RPM services after establishing a patient-provider relationship, and avoid, to the extent possible, using call centers to set up RPM services for patients.

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