Building a Compliant RPM Program: What the OIG Wants to See

Remote Patient Monitoring (RPM) continues to grow as a critical component of value-based care, but many clinics remain unaware that their vendor contracts could be putting them at risk.

Recent findings from the Office of Inspector General (OIG) reveal widespread compliance concerns in RPM billing, highlighting the importance of working with partners that uphold regulatory standards. Too often, vendors shift that compliance burden directly onto providers—sometimes without their knowledge.

Why RPM Compliance Matters

RPM offers a path to better outcomes and revenue, but it also comes with strict requirements under Anti-Kickback, Stark, and Fair Market Value (FMV) laws.

A California internist and former medical director for a national RPM company recently reviewed Telecare’s compliance framework and noted that it was the first truly compliant RPM program she had seen.

That acknowledgment underscores a vital point: compliance isn’t automatic—it must be built into every level of an RPM program, from contract structure to daily operations.

What’s Getting Clinics in Trouble

Even well-intentioned clinics can run into compliance issues when vendors use risky billing or pricing models. Common pitfalls include:

1. Per-Code Pricing

When a vendor’s fees increase based on your billed units or claim amounts, it can cross into Anti-Kickback Statute and Stark Law violations.

2. “Six Minutes per Reading” Models

RPM management codes (99457/99458) must reflect true monthly clinical management—not a stopwatch approach or quick device check.

3. Percentage of Collections

Paying vendors a percentage of your Medicare reimbursements links payment to the volume or value of claims—a clear FMV violation.

4. “No Pay if Denied” Clauses

Fee waivers tied to reimbursement outcomes can seem provider-friendly but are often viewed as prohibited, outcome-based compensation.

Each of these scenarios may sound convenient, but together they create significant compliance risk.

What the OIG Flagged in 2025

In its 2025 review of more than 4,600 practices billing RPM, representing over $500 million in Medicare payments, the OIG identified five key warning signs:

• Rapid or unexplained increases in RPM patients
  
  
• Weak provider–patient relationships
  
  
• Minimal evidence of ongoing clinical management
  
  
• Overlapping billing activity
  
  
• Multiple devices billed per patient per month
  
  

Clinics are encouraged to review their vendor relationships, confirm valid patient-provider engagement, and conduct periodic compliance audits to align with these expectations.

What Compliant Looks Like

A compliant RPM program should be transparent, consistent, and fully audit-ready. Look for these characteristics:

• Flat-fee, FMV-based contracts — pre-set, commercially reasonable rates unrelated to reimbursement outcomes.
  
  
• No percentage or per-code pricing structures.
  
  
• No waivers, bonuses, or incentives tied to payment results.
  
  
• Automatically transmitted device data — not self-reported readings.
  
  
• Detailed documentation of real clinical interactions and management activity.
  
  

By maintaining these standards, clinics can confidently build sustainable RPM programs that deliver both patient value and regulatory peace of mind.

The Bottom Line

Compliance isn’t just a legal requirement—it’s a business safeguard. With OIG scrutiny intensifying, clinics should ensure that their RPM partnerships are based on flat-fee, FMV-compliant agreements that protect against audit exposure.

If your current contract fluctuates with codes, payments, or denials, it’s not a strategy—it’s a liability.

Want to learn more about how our RPM programs protect your practice while delivering real results?

Contact Telecare-USA today to schedule a consultation.

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