In 2024, the Office of Inspector General (OIG) released a critical report titled Additional Oversight of Remote Patient Monitoring in Medicare Is Needed (OEI-02-23-00260), putting a spotlight on the growing risks in Medicare’s Remote Patient Monitoring (RPM) program. With RPM usage skyrocketing—jumping from 55,000 enrollees in 2019 to over 570,000 in 2022—and payments soaring past $300 million, the stakes have never been higher. But this growth comes with a catch: the OIG uncovered widespread issues that threaten practices with audits, penalties, and massive revenue losses. These aren’t just numbers on a page—they’re warnings every practice needs to heed. Intelligence Factory’s FairPath steps in to turn these risks into opportunities, ensuring your billing stays compliant and your payments keep flowing.

The OIG report found that 43% of RPM enrollees—over 244,000 patients in 2022—didn’t receive all three essential components: education/setup (CPT 99453), device supply (99454), and treatment management (99457/99458). Digging deeper, 28% missed education/setup, 23% lacked device supply, and 12% never got treatment management. That’s not just a paperwork slip—it’s a red flag. The OIG warns that incomplete services could mean providers are billing for care that’s not fully delivered, risking fraud accusations or claim denials. With $262 billion lost annually to denials across Medicare, these gaps hit practices hard, leaving revenue on the table and exposing you to regulatory scrutiny. FairPath analyzes your data to ensure every component is accounted for, keeping your practice safe and paid.

Billing mismatches are a glaring concern in the OIG report, flagged as potential fraud indicators that could trigger audits. Take this example: a practice bills 15 services for 99453 but only has 10 beneficiaries enrolled. That’s five extra setups with no patients to match—suggesting overbilling, sloppy records, or worse. The OIG found similar issues across RPM, noting that services exceeding beneficiaries or patients billed without devices (23% of cases) point to inaccurate reporting. These aren’t minor errors; they’re the kind of discrepancies that fuel the $300 million in RPM payments at risk in 2022 alone. FairPath catches these mismatches early, using AI to align services with patients so you avoid the OIG’s crosshairs.

The stakes go beyond a single claim. The OIG’s findings signal a crackdown on RPM billing, with practices facing audits if fraud indicators pile up—think penalties, repayments, or worse. Then there’s the denial trap: incomplete components and mismatches lead to rejected claims, contributing to that $262 billion annual loss across Medicare. For small practices, this isn’t just a statistic—it’s cash flow drying up, with 90% of payments delayed beyond 30 days turning into operational nightmares. FairPath doesn’t just spot these risks; it prevents them. Our platform ensures your billing data is bulletproof—every service documented, every claim compliant—so you dodge audits, cut denials, and secure what you’re owed, fast.

FairPath isn’t here to scare you—it’s here to solve this. Built by Intelligence Factory, our AI-powered platform dives into your Medicare data, analyzing hundreds of metrics to root out issues like these. Whether it’s catching a 99453 mismatch (15 services vs. 10 beneficiaries), ensuring treatment management follows device use, or flagging payment shortfalls, FairPath keeps your RPM program compliant and profitable. The OIG’s report is a wake-up call—43% of enrollees at risk, $262 billion on the line—but with FairPath, you’re ahead of the game, avoiding penalties and locking in revenue with precision.