1. Federal Law Prohibits Outcome-Based Compensation Tied to Medicare Claims

Federal laws like the Anti-Kickback Statute (42 U.S.C. §1320a–7b(b)) and the Stark Law (42 U.S.C. §1395nn) prohibit arrangements where compensation is tied to the value or volume of Medicare-reimbursed services. This includes RPM services billed under CPT codes such as 99453, 99454, and 99457.

2. Percentage-Based Fees Raise Kickback and Referral Concerns

Charging a percentage of what the doctor receives from Medicare or Medicare Advantage plans is considered ‘remuneration.’ Regulators view this as a potential inducement to refer services, which violates federal law even if the service itself is legitimate.

3. ‘No-Pay-if-Denied’ Models Are Risky and Potentially Illegal

Waiving our fees when a provider doesn’t get paid may seem helpful, but it legally constitutes a form of financial incentive that undermines fair market value requirements and creates risk under AKS and Stark Law.

4. CMS and OIG Require Fair Market Value (FMV) Compensation

The Office of Inspector General (OIG) has clearly stated that compensation must be set in advance, commercially reasonable, and not tied to reimbursement. We only offer flat-fee RPM agreements that comply with this standard.

5. Protecting You (and Us) from Regulatory Audits and Penalties

Improper compensation models can trigger investigations, audits, and severe penalties for both the provider and the service company. We prioritize compliance to protect your practice from avoidable legal risk.

6. Our Flat-Fee Model Is Compliant and Transparent

We charge a fixed monthly fee per enrolled patient for RPM services if we achieve a billing code for you. If we do not get a billing code, then we did not deserve to be paid as we did not perform the services you are expecting. This ensures transparency, compliance, and peace of mind — while letting you retain 100% of your reimbursements.

Don Self, CMCS, CPC, CASA

President, TELECARE-USA