Let’s Fight RPM Fraud Without Taking Remote Care Away from Patients
An Open Letter to:
The Honorable Dr. Mehmet Oz
Administrator of the Centers for Medicare & Medicaid Services
Dear Dr. Oz:
As a cardiothoracic surgeon, you understand that heart disease does not follow office hours. Blood pressure can rise silently. Heart-failure patients may gain dangerous fluid weight before realizing something is wrong. Remote Physiologic Monitoring and Remote Therapeutic Monitoring provide the means for care teams to identify these warning signs before they lead to emergency department visits, hospitalizations, strokes, or deaths.
Heart disease remains the leading cause of death in the United States. That makes CMS’s proposed restriction on contracted clinical staff participating in RPM and RTM especially concerning.
Under the proposed CY 2027 Medicare Physician Fee Schedule, practices may no longer be able to use qualified contracted clinical teams to perform billable remote-monitoring services. Instead, the staff may need to be directly employed by the billing practice.
In theory, this may appear to improve accountability. In practice, it could cause many RPM and RTM programs to disappear, ultimately harming the patients whom CMS serves.
Most Clinics Cannot Build These Programs Internally
Effective remote monitoring requires much more than distributing a blood-pressure cuff. It requires patient education, device support, regular review of readings, documentation, clinical escalation, follow-up, billing compliance, and trained personnel.
Most small, independent, specialty, and rural practices do not have the staffing, technology, or financial resources to build this infrastructure internally. Many already struggle with nursing shortages, rising administrative costs, and difficulty recruiting clinical staff. If this legislation is finalized, many of these practices will be unable to deliver these services directly, which will ultimately harm their patients.
Qualified third-party organizations allow these practices to offer remote monitoring under the supervision of the treating provider. If contracting with outside vendors is prohibited, large health systems will have the means to continue these programs, but smaller clinics may be forced to eliminate them.
The patients most affected will be those in rural and underserved communities.
Rural Patients Will Be Harmed the Most
Rural Americans already face fewer physicians, longer travel distances, hospital closures, and limited access to specialists. For older adults with heart failure, hypertension, diabetes, lung disease, or mobility limitations, remote monitoring may be the only practical way to receive consistent care between office visits.
These clinics will not suddenly hire complete internal monitoring teams. In many communities, the necessary workforce does not exist.
The services will simply end.
Fight Fraud Without Ending Access
We understand that CMS is concerned about fraud and abuse. Some organizations may have enrolled patients improperly, billed without sufficient monitoring, shipped unnecessary devices, or failed to provide meaningful clinical services.
CMS should aggressively pursue those organizations.
However, banning all contracted clinical staff because of misconduct by some participants would punish legitimate providers and patients. Employment status alone does not determine whether care is appropriate or compliant.
A contracted nurse operating under physician-approved protocols, documenting services, communicating with the practice, and escalating abnormal findings may provide excellent care. A directly employed staff member may still provide inadequate care or cross the line with respect to fraud, waste and abuse concerns.
CMS should regulate the quality and legitimacy of the services not simply the payroll relationship.
A Better Solution
Instead of eliminating contracted RPM and RTM services, CMS should establish stronger oversight requirements.
CMS could:
- Require an established provider-patient relationship and documentation of medical necessity;
- Prohibit unsolicited patient enrollment;
- Require registration or certification of third-party monitoring organizations;
- Identify the contracted organization on Medicare claims;
- Require written clinical protocols and escalation procedures;
- Audit transmitted readings, communication records, and staff time;
- Monitor unusual billing and enrollment patterns;
- Require reporting of patient engagement and clinical outcomes;
- and Impose serious penalties on organizations that submit fraudulent claims.
These safeguards would allow CMS to identify bad actors while preserving access to legitimate services.
Do Not Confuse Employment with Accountability
The billing practitioner must remain responsible for the patient’s care. That responsibility should never be outsourced.
But responsibility does not require every person involved in care to be a direct employee.
Healthcare organizations routinely rely on specialized contractors. The real risks are poor supervision, missing documentation, inadequate communication, and fraudulent billing. CMS should address those problems directly.
Dr. Oz, remote monitoring supports thetransition from reactive healthcare to preventive chronic-disease management. Properly supervised RPM and RTM programs can help patients manage hypertension, heart failure, and other serious conditions before they result inhospitalization.
Please preserve the ability of medical practices to use qualified contracted clinical personnel. Establish strict standards. Require transparency. Audit aggressively. Remove fraudulent organizations from Medicare.
But do not eliminate remote monitoring for the patients who need it most. For many rural and chronically ill Americans, this is not merely a question of who employs the care manager. It is a question of whether the care will exist at all.
Respectfully,
SoheilSaadat, Ph.D.
ChiefExecutive Officer
GenieMD,Inc.