Remote patient monitoring false claims settlement and fraud alert highlight medical necessity
A recent false claims settlement and consumer fraud alert are good reminders of the importance of medical necessity and respecting medical judgment when furnishing or billing for remote patient monitoring services.
Remote cardiac monitoring false claims settlement
On December 18, 2023, the Department of Justice, DOJ, announced a False Claims Act settlement with BioTelemetry Inc. and its subsidiary, LifeWatch Services Inc., the “Companies,” for submitting claims to federal health care programs for levels of remote cardiac monitoring services that were higher and more expensive than ordering physicians intended, or were not medically necessary.
In summary, the allegations focus on marketing and enrollment processes for remote cardiac monitoring services ordered by personnel associated with health care providers, such as hospitals and physician practices, listed as “Accounts” on an attachment to the Settlement Agreement. The United States alleged that the Companies marketed a Company cardiac monitoring device to physicians for three types of heart monitoring services, holter monitoring, cardiac event monitoring and mobile cardiovascular telemetry, knowing that the Company online enrollment portal was designed to cause unwitting clinical staff to enroll patients for the type of remote cardiac monitoring that provided the highest payment to the Companies, even if the physician intended to order a less expensive service. The United States also alleged that Company sales personnel instructed Account personnel to order mobile cardiovascular telemetry services, separately or in combination with holter monitoring, even if the Companies knew that the physician intended to order event monitoring services, which were less expensive, and that the Companies disregarded notes from Account personnel regarding the types of monitoring requested.
LifeWatch agreed to pay over $14.7 million. The whistleblowers, or relators, who brought the case, will receive nearly $2.6 million of this settlement amount.
In the press release, U.S. Attorney Philip R. Sellinger for the District of New Jersey states:
"Our health care system is based on doctors choosing the level of care appropriate for their patients," said Sellinger. “It undermines this system and costs taxpayers if companies design systems that make it harder for physicians to order only necessary services and also use their sales force to mislead health care practitioners, as we allege happened here. Our office is committed to holding accountable companies who try to take advantage of the system in these ways."
Remote patient monitoring consumer fraud alert
Several weeks prior to the Settlement Agreement, the U.S. Department of Health and Human Services Office of Inspector General, OIG, issued its consumer alert on remote patient monitoring. The alert warned the public of fraud schemes involving scammers who sign up Medicare enrollees for remote patient monitoring services without regard to medical necessity. The Alert notes that scammers target Medicare enrollees and steal personal information and then bill Medicare for services that are unnecessary or never provided.
The Centers for Medicare & Medicaid Services, or CMS, has extended Medicare coverage for remote physiologic monitoring, RPM, and remote therapeutic monitoring, RTM, over the last four years, and recently updated RPM and RTM billing standards in the Medicare Physician Fee Schedule 2024 Final Rule.
Action steps for remote patient monitoring providers and companies
Providers who furnish RPM, RTM, remote cardiac monitoring, or other types of remote patient monitoring, along with companies that provide staffing, IT, or other services relating to remote patient monitoring, should take note of this settlement and the Consumer Alert and should consider possible action steps, such as:
- Review and update policies and procedures to address and document medical necessity for remote patient monitoring services
- Review and design portals, websites and other communications to avoid potential allegations of distorting the professional judgment and decision-making of health care practitioners, clinical staff or others involved in ordering remote patient monitoring services
- Review financial, employment, contractual and referral relationships for elements that could be viewed as clouding professional judgment of ordering professionals.