September 22, 2025
The Office of Inspector General (OIG) recently released two studies highlighting areas where oversight is needed to ensure the integrity and effectiveness of Medicare services.
Billing for Remote Patient Monitoring in Medicare
OIG found that:
The use of remote patient monitoring continued to grow in 2024, with Medicare payments exceeding $500 million.
Monitoring billing can help safeguard the Medicare program and prevent fraud, waste, and abuse.
OIG developed several measures to monitor billing for remote patient monitoring, including (1) billing for a high proportion of enrollees who have no prior history with the medical practice, and (2) billing for multiple monitoring devices a month for an enrollee.
These measures can identify medical practices with billing for remote patient monitoring that warrant further scrutiny.
Analyzing billing can help the Centers for Medicare & Medicaid Services (CMS), Medicare Advantage Organizations, and other entities ensure that enrollees receive the benefit of remote patient monitoring while, at the same time, minimizing program integrity risks.
The OIG found that:
Nursing homes failed to report 43 percent of falls with significant injury and hospitalization among Medicare-enrolled residents, as required, in resident assessments.
For-profit and chain nursing homes, as well as larger nursing homes, failed to report falls most often.
Fall reporting varied widely by state and was worse among nonrural nursing homes.
Nursing homes failed to report falls more often for younger residents, male residents, short-stay residents, and residents with only Medicare coverage.
Nursing homes’ failure to report falls on MDS assessments leads to inaccurate fall rates on Care Compare.
Nursing homes with the lowest fall rates on Care Compare were the least likely to report the falls that were examined. This suggests that low fall rates for nursing homes on Care Compare are likely driven by nursing homes’ failure to report falls, rather than an actual low incidence of falls.
As a result, Care Compare does not provide the public with accurate information about how often nursing home residents fall.
OIG released a companion data snapshot describing the reviewed falls, the characteristics of the residents who fell, and the characteristics of the nursing homes where the falls occurred.
What OIG Recommends
CMS should take steps to ensure the completeness and accuracy of the nursing home-reported MDS data used to calculate the quality measures for falls with significant injury.
CMS should explore whether approaches to improve the quality measures related to falls could similarly be used to improve the accuracy of other nursing home quality measures.
CMS concurred with both recommendations.