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RPM Drama, DiMe AI Governance, and Behavioral Health Sabotage
By Jason Barry, Jack Troy, Virginia Hunt
July 23, 2026
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Together with
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“Remote patient monitoring was created to make high-quality care more accessible and affordable – not more difficult to deliver – especially for rural and underserved communities facing significant workforce shortages. The challenge is strengthening oversight while preserving the collaborative care models that help providers expand access, extend clinical capacity, and deliver high-quality longitudinal care at scale.”
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Brook.ai CEO & Founder Oren Nissim
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Here’s an updated DHW with the correct version that showcases my nonexistent photoshop skills. A technical glitch (vacation brain) impacted the first send;)
Jason
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And the flag is out! or at least it’s being proposed!
Third-party remote patient monitoring vendors were caught offside in the proposed rule for the 2027 Medicare Physician Fee Schedule, which would bar reimbursement for RPM services unless they’re performed by clinical staff that’s directly employed by the practice doing the billing.
Drastic times call for drastic measures. CMS’s proposed change follows widespread concerns over skyrocketing costs for low-value services. Medicare started covering RPM in 2018, and payments ballooned to more than $500M by 2024.
- An OIG watchdog report – also 2024 – showed that 43% of Medicare beneficiaries receiving RPM weren’t getting at least one of the three required components: devices, education/setup, and treatment management.
- It also pointed out that Medicare lacks basic information needed to properly bill for RPM, like who ordered the monitoring in the first place.
CMS means business. Although the OIG’s concerns seem like some pretty good levers to pull before taking the nuclear option, the latest estimates show that Medicare could recover over $4B from criminal cases filed in the last six months alone.
The proposed rule pins the problem on vendors:
- Medicare would only reimburse RPM and RTM when they’re performed by clinical staff employed by the billing practice, not third-party companies (pretty much every RPM company we’ve ever covered).
- The rule would also require a separate visit to kick off any remote monitoring episode, limiting the service to patients that have an established relationship with the billing practice.
That would effectively end RPM as we know it. CMS is proposing to throw the baby out with the bathwater, eliminating the bad actors at the expense of the good ones – and their patients.
The initial response was predictably… not great:
- Brook.ai CEO Oren Nissim summed it up nicely. “We fully support CMS’s goal of ensuring remote care is driven by clinical need, integrated into physician-directed care, and delivered through close collaboration between physicians and integrated clinical teams. The challenge is strengthening oversight while preserving the collaborative care models that help providers expand access, extend clinical capacity, and deliver high-quality longitudinal care at scale.”
- Cadence CEO Chris Altech shared a similar sentiment. “The challenge is that the proposal doesn’t distinguish at all between low quality RPM and clinically integrated programs… The result of the current rule in its current form will be more untreated chronic disease, higher downstream costs for Medicare.
The Takeaway
There’s a ton of fraud in Medicare. There’s even more waste. Does that mean burning RPM to the ground is the best solution? You can let CMS know what you think until September 16th.
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- Behavioral Health Un-Covered: A beautiful investigation by Dr. Seth Glickman in HEALTH CARE un-covered found that UnitedHealth Group bought up hundreds of brick-and-mortar behavioral health clinics across the country, then quietly shuttered many of them while leaning into its virtual mental health businesses. The analysis found that over half of the clinics UnitedHealth acquired either closed entirely or axed at least one office, including ~90 offices and 572 jobs when Optum shuttered its behavioral health services in New Jersey. The investigation put the spotlight on closures that mostly happened out of public view, and offered a grim look at what happens “when Wall Street logic collides with community mental healthcare.”
- Eli Lilly Invests in Oura: One of pharma’s biggest giants just invested an undisclosed sum in Oura, following a presumably successful partnership that recently made the smart rings available to GLP-1 patients on LillyDirect. The funds were earmarked to expand the collaboration and help more patients monitor their vitals while managing their weight, and apparently over 100k members have already logged GLP-1 use in the Oura app to see how their routines impact their physiology. This is also the latest in a string of checks that Lilly’s been cutting for some of the biggest names in digital health.
- Operationalizing AI Governance in Healthcare: DiMe is taking a major step toward transforming AI governance from a barrier into an enabler of responsible AI adoption with the launch of Operationalizing AI Governance in Healthcare. The initiative was developed alongside Qualified Health and 30+ participating orgs to build the governance resources health systems have been calling for. We’ll point you toward each resource as they’re rolled out, so stay tuned for risk assessment templates, performance monitoring guides, and other practical tools ahead of DiMe’s full showcase at HLTH.
- TytoCare Gets $25M & New CEO: TytoCare hauled in $25M of growth funding to write the next chapter of its “AI-first clinical enablement platform.” The platform combines a handheld examination platform featuring FDA-cleared medical devices to capture clinical-grade heart, lung, ear, skin, throat, and to abdomen data, as well as a suite of FDA-cleared algorithms that enable clinicians to conduct comprehensive remote physical exams. TytoCare also brought on some seasoned authors to help write the post-funding story: new CEO Adam Pellegrini and COO Greg Orr.
- AI Top of Mind Worldwide: It’s not just the American medical system that’s clamoring for AI. An annual KLAS Research survey found 57% of 182 non-U.S. healthcare organizations view AI as a top IT investment priority, surpassing EHRs and digitization (44%), broad IT infrastructure (26%), and cybersecurity (25%). Ambient listening took the cake as the most exciting AI innovation (57%). Despite all this AI buzz, 37% of respondents are still in early innings, working through high-level strategy, governance frameworks, and readiness assessments.
- LifeMD on Blast: Former LifeMD employees told STAT the popular telehealth platform is doling out GLP-1 prescriptions with little screening or follow-up. Sources described loose charting, slow responses to urgent patient messages, and strict productivity goals, with doctors expected to review up to 25 cases per hour. LifeMD strongly denied the allegations. Even so, the story speaks to fears that online prescribers, encouraged by favorable arrangements with Novo Nordisk and Eli Lilly, can lose sight of patient safety amid the GLP-1 gold rush.
- WHOOP for Surgical Recovery: WHOOP and Kinomatic, a surgical planning startup, embarked on their RESTORE pilot to smooth recovery and reduce opioid dependence after joint replacement. Patients get a WHOOP band in their recovery kit that tracks heart rate variability, respiratory rate, and sleep patterns to see how they’re healing, while also measuring steps to ensure they’re not overexerting their new knee or hip. The 12-week test run covers just a few clinics, but could expand to the wider Kinomatic network next year.
- Working in Concert: Lyric is beefing up its payment integrity platform for health plans by acquiring Concert, a small firm that makes sure diagnostic and precision medicine tests are correctly ordered, reviewed, and reimbursed. The companies have collaborated on test management since 2023, so the move isn’t totally unexpected. If Lyric sounds unfamiliar, that’s probably because the claims editing software giant went by ClaimsXten for most of its history. In 2025, Lyric absorbed ClaimShark to give the larger platform an AI/cloud foundation.
- Abortion Pill Case Could Crumble Telehealth: A Health Affairs article warns that Louisiana’s case over the virtual prescription and mailing of mifepristone could destroy telehealth. The suit’s reasoning contends that the FDA infringed upon state sovereignty. That rationale could undermine the legality of >40% of calls that end in prescriptions for medications ranging from cold medicine to cancer drugs. Nearly three-quarters of physicians use telehealth weekly to see rural and elderly patients— gutting the platform could also mean cutting their access to lifesaving drugs.
- Campaign Champions AI in Public Health: The Coalition for Health AI has launched their PULSE initiative to scale AI use in public health agencies. CHAI has partnered with OpenAI and Anthropic to give 10 enterprise licenses to state, tribal, and local agencies, enabling 2k health professionals to pilot generative tools. Up to 40% of local public health organizations aren’t using AI, but want to. CHAI’s initiative could close that gap, giving selected participants the ability to write playbooks on AI use for biosurveillance, data retrieval, and more.
- Autonomize Unbottles Genie AI: Autonomize AI’s newly-released Genie AI agent uses natural language to build out custom clinical workflows. The system can streamline a slew of to-dos, from commonly automated tasks like billing and insurance queries to more complex projects, like identifying, prioritizing, notifying, and tracking high-risk patients in need of follow-ups. Genie’s release comes a year after Autonomize’s $28M Series A round, and with partners like Microsoft and Nvidia, it doesn’t seem like the company needs wishes or lamps to ensure its success.
- Karoo Nabs $16M for Cardiac OS: Karoo Health closed a $16.2M Series A round to build out its AI-native operating system for cardiovascular care. The platform aims to connect payors, providers, and patients through workflow data analysis, supporting earlier risk detection and care coordination. The company will use the proceeds to further develop its platform, including predictive models and clinical signal detection, while expanding its team and scaling payor and provider deployments.
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- Abridge Named #1 Best in KLAS – Again: KLAS just named Abridge #1 Best in KLAS for Ambient AI for the second year in a row. The recognition was based on direct customer feedback from the nation’s largest and most complex health systems, which gave Abridge the highest overall satisfaction score and A+ ratings across Culture, Loyalty, Relationship, and Value. Discover why Abridge is the market-leading AI platform for clinical conversations.
- State of Payor Enrollment and Credentialing: Over half of provider orgs are losing revenue due to credentialing delays – with many missing out on over $1M annually. Medallion’s new report unpacks the forces quietly undermining operational and financial performance, and how leaders across the industry are addressing them. Head over to the full report to get insights tailored to your role and org type.
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