Medicare fraud can be curbed without cutting off high-need patients

A recent proposal from the Centers for Medicare & Medicaid Services gives Congress a chance to tackle two critical goals at once: preserving access to lifesaving care for the patients who rely on it most and making sure taxpayer money is spent wisely. As a geriatric nurse practitioner, I understand how vital it is for patients to get the care they need, and I also believe Medicare must be protected from waste, fraud, and abuse. By adopting new technology and improving accountability, we can serve patients better while ensuring public dollars are used appropriately.

To achieve both aims, access to remote patient monitoring must be preserved.

Remote patient monitoring, or RPM, enables healthcare professionals to track a patient’s health data through a digital device even when they are not at the bedside. It is especially useful for people in rural areas who may live far from the nearest hospital or clinic. By helping providers follow chronic conditions and step in when needed, RPM can deliver timely care without forcing patients into repeated office visits.

That matters even more in rural America, where long travel distances, limited specialty care, and fewer local clinicians are common. A 24/7 clinical monitoring model can allow patients to get attention when they need it while staying at home instead of waiting until their condition becomes severe enough to require a hospital visit. Some responsible providers in this space have reported hospital admissions dropping by more than 27% among these patients.

To keep those benefits intact, lawmakers from both parties should work with CMS to protect access to these services for more than 1 million Americans, many of them rural seniors living with serious conditions such as heart disease, cancer, and hypertension.

When used properly, RPM helps people remain healthier at home, prevents avoidable hospitalizations, and lowers Medicare spending. Concerns about waste, fraud, and abuse in RPM are real, but the answer is stronger oversight and accountability so Medicare dollars go to patient care rather than bad actors. Medicare should never reimburse for data that no clinician meaningfully reviews, or for a billing setup in which the physician has little relationship with the patient and little responsibility for the care provided. Patients deserve assurance that a qualified clinician is reviewing their information, and taxpayers deserve clear billing rules that do not subsidize poor-quality service.

To address these problems, CMS has proposed limiting Medicare payment for RPM to cases in which the clinical work is done by staff directly employed by the billing physician or practice. Although intended to improve oversight, that change could block practices that rely on contracted clinical teams from being reimbursed for these services. Combined with new visit requirements and a restructuring of billing codes, the policy could effectively wipe out this sector, undoing major gains and pushing millions of families, providers, districts, and states into financial strain.

If the proposed 2027 Physician Fee Schedule change under review at CMS moves forward, cancellation notices could start reaching older patients in Virginia, North Carolina, Michigan, Texas, and many other rural states in late October. In Virginia, where I represent the 2nd Congressional District, thousands of patients would be affected. CMS should also weigh how these changes could affect the Rural Health Transformation Program, a major part of last year’s working families’ tax cut. That program includes more than $50 billion in investments to strengthen rural healthcare, including broader access to telehealth and other digital health services.

The issue is not whether Washington should act, but how. Policymakers must hold bad actors accountable without weakening the legitimate programs that help seniors stay healthier at home and reduce Medicare costs. That includes programs Congress and the administration have already supported with major federal investments to improve care and expand access to healthcare services.

The industry needs strong guardrails, and the administration should work with Congress and honest participants in healthcare to build them. But a broad ban on contracted clinical staff will not achieve that goal. CMS already has the tools to separate accountable care from unaccountable billing. Instead of imposing a sweeping employment test, CMS should focus on whether a real clinician is responsible for a real patient. For example, it could require RPM services to be documented in the patient’s electronic health record rather than requiring every member of the care team to be on the same payroll.

In this Congress, modernizing rural healthcare and rooting out waste, fraud, and abuse have been key priorities, and I remain committed to advancing both. CMS now has an opportunity to get this right: protect taxpayers by targeting abusive practices, demand genuine clinical accountability, and preserve technology-enabled care that helps seniors avoid unnecessary hospital stays.

This would be a victory for Medicare, for rural patients and providers, and most of all for the millions of patients who want to stay healthy at home. I urge CMS to rethink this policy change or at least delay implementation to allow more time for discussion. As commonsense conservatives, we can eliminate waste, fraud, and abuse while preserving access to innovative healthcare services that improve outcomes and safeguard taxpayer dollars.

Rep. Jen Kiggans has represented Virginia’s 2nd District since 2023. Before entering Congress, she worked as a geriatric nurse practitioner caring for seniors and gained firsthand experience with the challenges patients and healthcare providers face. As vice co-chairwoman of the Congressional Nursing Caucus, she remains focused on improving healthcare affordability, expanding access to quality care, and protecting Medicare for America’s seniors.