Krista Drobac weighed in on inaccuracies found in the OIG report in Health Leaders. Pointing out five inaccuracies and areas of bias, Drobac shared with the publication, “There is no context about fraud in the Medicare program,” she wrote. “In the same year that the entirety of RPM claims were $311 million, the false claims alone in Medicare were $31.2 billion. That tells a different story than the misleading headline and pull-out statements in the report. If we applied the fraud amount in the rest of the program of 3-10%, the fraud in RPM would have been between $9.3 million and $31 million in 2022. That’s less than .01% of the fraud in Medicare.”

She cited three key errors:

1. The OIG says there is no order requirement for RPM, but that requirement is included in Medicare’s 2021 Physician Fee Schedule as well as in guidance from Medicare Physician Contractors.
   
2. There is no CMS requirement that an RPM device be “internet-connected.”
   
3. CMS has not officially adopted the 16-days-in-30 data collection rule as a requirement, and said in the 2024 Physician Fee Schedule that it was not a requirement to receive Medicare reimbursement under CPT codes 99457 and 99458.

“We would be happy to work with you on designing and recommending tools to address the real fraud that is happening in the Medicare program,” Drobac concluded. “Better control of inappropriate Medicare enrollment, solicitation, and prescribing while instituting stronger monitoring and audits to ensure fraudulent providers are caught sooner and weeded out of the system.”