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  "documentTitle": "iRhythm Technologies, Inc. (IRTC)",
  "authorId": "54_Spruce_Point_Capital",
  "authorName": "Spruce Point Capital Management",
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  "presentationDate": "2025-08-18 00:00:00",
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  "notes": "Uses a combination of regulatory precedent (HHS) and employee testimony (Glassdoor) to build a case for potential fraud.",
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      "text": "Based on our review of LinkedIn and other sources, we believe a large volume of CCTs in the US are located in remote locations. Not only does this suggest the opportunity for questionable reimbursement practices on the part of iRhythm, but we believe it also calls into question iRhythm management's numerous claims related to the build-out of its CCT \"Center of Excellence\" in San Francisco. Importantly, as indicated by Glassdoor reviews presented earlier, current and former CCTs located in San Francisco bemoaned the negative impacts of increased outsourcing of CCTs from that location to offshore locations. We are unable to reconcile this inconsistency.",
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      "text": "Based on our review of LinkedIn and other sources, we believe a large volume of CCTs in the US are located in remote locations. Not only does this suggest the opportunity for questionable reimbursement practices on the part of iRhythm, but we believe it also calls into question iRhythm management’s numerous claims related to the build-out of its CCT “Center of Excellence” in San Francisco.",
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      "text": "Spruce Point Capital Management",
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      "kind": "paragraph",
      "text": "iRhythm must perform results analysis activities for CMS patients at Medicare-enrolled independent diagnostic testing facilities (IDTFs) that must meet certain performance standards. The Company's facilities in California, Illinois, and Texas (Houston) are approved IDTFs. CMS patients accounted for 24% of 2024 revenue. However, based on our analysis of LinkedIn, we estimate that 63% of iRhythm CCTs are located in remote locations outside the three IDTF metropolitan areas, and, triangulating on several data points, we estimate that only 17% of total global CCTs are located in the three IDTFs. While CMS regulations approve the use of remote CCTs, the reimbursement rates sought by iRhythm must match the costs incurred where the data was actually analyzed. We assume that the Company's facilities in California (San Francisco) and Illinois (Deerfield) are much higher cost (and thus receive higher reimbursement) than most remote CCTs. Therefore, iRhythm may be overbilling CMS for CCTs that are actually located in low-cost locations. IDTF billing violations are an area of historic focus for the U.S. Department of Health and Human Services (HHS). At least one employee highlighted this practice by iRhythm on Glassdoor. If true, this would suggest that iRhythm revenues are inflated and that the Company is at risk of additional regulatory sanctions.",
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      "text": "Cons Scams Medicare ... Created a program to capitalize on Medicare by scanning the majority of their scans in a state where Medicare pays more. — Advanced Patch Technician, iRhythm, 4/10/24, Glassdoor",
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      "text": "Source: HHS, Department of the Inspector General, Glassdoor, Spruce Point research",
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      "kind": "title",
      "text": "Is iRhythm Committing Medicare Billing Violations Related To Its IDTFs?",
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