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    05/24/2016
    HME News Staff

    WASHINGTON – AAHomecare and The VGM Group will merge their respective consumer advocacy groups into one industry wide platform.

    Per the merger, AAHomecare’s Save My Medical Supplies and VGM’s People for Quality Care will combine under the PFQC brand.

    “This coordinated, collaborative effort builds upon our past successes, while streamlining advocacy efforts to maximize impact,” said Tom Ryan, president and CEO of AAHomecare.

    The groups aim to use their collective influence and resources to better reach, educate and engage consumers who have been negatively impacted by poor healthcare policies, and to share their messages with Congress.

    AAHomecare officially launched Save My Medical Supplies with a website, and Facebook and twitter pages in April 2014. Among its accomplishments: A campaign that generated more than 5,500 letters in 90 days asking Congress to reform harmful Medicare policies.

    PFQC, launched by VGM in 2010, has been behind a number of initiatives aimed at fighting these policies, including a “Dear Medicare” website featuring stories of seniors and people with disabilities who are being negatively impacted; an interactive map with data on beneficiary complaints across the country; and a “Faces Behind the Red Tape” online video series specifically documenting the impact of audits on beneficiaries.


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    05/25/2016
    HME News Staff

    WASHINGTON – The National Federation of Independent Business has written a letter in support of H.R. 5210, a bill that would delay the second round of Medicare reimbursement cuts scheduled for July 1.

    “This legislation…is critical to providing the certainty necessary for America’s small suppliers and providers to continue to meet the needs of the communities who depend on their services,” the letter states.

    The NFIB is a non-profit organization that represents 325,000 small and independent business owners nationwide. 

    In April, NFIB wrote a similar letter in support of S. 2736.


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    05/26/2016
    HME News Staff

    WASHINGTON – A significant chunk of Round 2 contract suppliers did not meet all licensure requirements, according to a new report from the Office of Inspector General.

    “Of the 146 suppliers covered in our audit, 69 suppliers met licensure requirements,’ stated the OIG. “However, 63 suppliers did not meet licensure requirements for some of the competitions for which they received a contract.”

    An additional 14 suppliers need further research to determine whether they met licensure requirements, the agency said.

    The OIG reviewed documentation for contract suppliers in 50 CBAs in 11 states: Tennessee, Ohio, Maryland, Louisiana, Virginia, New York, California, Florida, Georgia, Michigan and Mississippi. The documentation was obtained from CMS, the National Supplier Clearinghouse and the Competitive Bidding Implementation Contractorregarding the processes used to ensure that contract suppliersmet licensure requirements.

    Round 2 of the competitive bidding program kicked off July 1, 2013 and will end on June 30.

    Stakeholders have said they hope that lessons have been learned in the wake of the Round 2 licensure debacle, which led may states to implement licensure laws to limit low-ball bids from out-of-state companies that have no intention of servicing the contracts.

    The OIG states that the licensure database CMS used when awarding Round 2 contracts was incomplete. The agency recommended that CMS (1) complete the research required to determine whether 14 suppliers had a proper license and make a licensure determination regarding those suppliers; (2) identify all applicable state licensure requirements to prevent suppliers that do not have all currently required licenses from receiving contracts in future rounds of the competitive bidding program; and (3) work with state licensing boards to better coordinate, identify, and maintain an accurate and complete licensure database of currently required State licenses. CMS concurred and discussed steps it had and will take regarding the first two recommendations. CMS did not concur with the OIG's third recommendation.


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    05/27/2016
    Liz Beaulieu

    WASHINGTON – With precious few Congressional days left to stave off an upcoming second round of Medicare reimbursement cuts, the sense of urgency at the AAHomecare Washington Legislative Conference on Wednesday was palpable.

    John Letizia, the chairman of the board of the association, set the tone for the event in his opening remarks when he said of the event’s more than 200 scheduled Hill visits, “Good luck and let’s give them hell.”

    Tom Ryan, president and CEO of the association, followed up later in the day with, “Be outraged. The standard of care is changing. We’ve got to get this done.”

    HME providers face an additional cut of 25%, on average, in non-bid areas on July 1. A previous cut of 25% already went into effect on Jan. 1.

    The stakes are high. A panel of rural providers discussed in grim terms the impact of the first round of cuts on their businesses and their ability to care for patients.

    “I’ve always said (to the owner of my company), ‘I’ve got this,’” said Cathy Hamilton, CFO at Coastal Med Tech in Ellsworth, Maine. “I’ve no longer got this.”

    Pat Naeger agreed.

    “For the first time in my adult life, I’m scared as hell and I’m mad as hell,” said Naeger, president of Healthcare Equipment & Supply Co. in Perryville, Mo. “We’re teetering on the edge.”

    Just in time, the industry now has on its side a new OIG report criticizing the bid program and 75 consumer groups. The event’s keynote speaker, Peter Thomas, a healthcare attorney who coordinates policy for the ITEM Coalition, told attendees that the group voted that week to authorize a letter supporting bills in the House of Representatives and Senate to push back the second round of cuts to at least Oct. 1, 2017.

    “Take the letter and use it,” he said. “Tell (lawmakers), ‘It isn’t just us.’”

    One lawmaker that doesn’t need convincing is Rep. Renee Ellmers, R-N.C. She has connected the dots that reduced spending for DME will only result in increased spending for acute care.

    “If you want to save money, keep patients out of the emergency room—it’s that basic,” said Ellmers, a former nurse, to a round of applause. “It’s common sense.”


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  • 05/27/16--08:20: ALJ wait time increases
  • OMHA, C2C pick away at backlog, but still no ‘broad relief’
    05/27/2016
    Theresa Flaherty

    WASHINGTON – The wait time for an Administrative Law Judge hearing keeps growing—a symptom of ongoing problems with the audit process, say industry attorneys.

    “I don’t think the problem lies in appeals,” said Ross Burris, an attorney in the Atlanta office of Polsinelli. “The problem lies lower down, either with audits that are too broad, or MACs that are just rubberstamping what the audit contractors are doing.”

    In the first quarter of 2016, the wait was 796 days. By the second quarter, it was 861 days—a 30% increase over the same period last year, when the wait was 661 days, according to a recent update from AAHomecare.

    The Office of Medicare Hearings and Appeals has taken some steps to reduce the backlog. A settlement conference pilot project brings the provider and CMS together with a facilitator to try and work out a settlement.Although the pilot was tweaked in October, the bar—such as having a minimum of 20 claims or $10,000 at issue—remains too high for most HME providers, say stakeholders.

    “I think OMHA is doing everything it can,” said Burris. “I think they have tried to increase the number of judges hearing appeals, and I think they’ve tired to come up within solutions within their small realm of power.”

    Another demonstration project, launched early this year by C2C Innovative Solutions, the Qualified Independent Contractor for the second level of appeals, allows HME providers to discuss denials over the phone before a decision is made.

    “These are steps in the right direction, but there’s so many suppliers and so many claims that have been audited,” said Stephanie Morgan Greene, chief consulting officer & general counsel for Acu-Serve. “You just don’t feel a broad sense of relief across the board.”

    While long wait times have not deterred most providers from appealing claims to the ALJ, they have forced them to take a harder look at the reasons for denials.

    “There have been so many denials for technical reasons that people want to go to the ALJ,” said Greene. “But they are also looking at what they need to fix, what trends they are seeing in denials, and truly attempting to fix things from the front-end processes.”


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    05/27/2016
    HME News Staff

    WASHINGTON – AAHomecare and The VGM Group will merge their respective consumer advocacy groups into one industry wide platform.

    Per the merger, AAHomecare’s Save My Medical Supplies and VGM’s People for Quality Care will combine under the PFQC brand.

    “This coordinated, collaborative effort builds upon our past successes, while streamlining advocacy efforts to maximize impact,” said Tom Ryan, president and CEO of AAHomecare.

    The groups aim to use their collective influence and resources to better reach, educate and engage consumers who have been negatively impacted by poor healthcare policies, and to share their messages with Congress.

    AAHomecare officially launched Save My Medical Supplies with a website, and Facebook and Twitter pages in April 2014. Among its accomplishments: A campaign that generated more than 5,500 letters in 90 days asking Congress to reform harmful Medicare policies.

    PFQC, launched by VGM in 2010, has been behind a number of initiatives aimed at fighting these policies, including a “Dear Medicare” website featuring stories of seniors and people with disabilities who are being negatively impacted; an interactive map with data on beneficiary complaints across the country; and a “Faces Behind the Red Tape” online video series specifically documenting the impact of audits on beneficiaries.

    KCI fights CMS’s decision

    SAN ANTONIO – KCI may have not been awarded contracts for negative pressure wound therapy as part of the Round 2 re-compete of competitive bidding, but it’s not going down without a fight.

    KCI, the largest provider of NPWT, says CMS’s decision to not award contracts to the company was based on a technical disqualification that it is working to resolve.

    “CMS’s decision is not final and we are working with CMS and the agency’s contractor, CBIC, to resolve the eligibility issue,” it stated in a May 19 letter to customers. “We expect to be able to share more information in the coming weeks.”

    KCI did not elaborate on the technical disqualification.

    The company is also exploring “alternative pathways” to ensure Medicare beneficiaries have continued access to its V.A.C. Therapy in affected areas if it is, ultimately, not awarded contracts, it stated in the letter.

    KCI received about $77.1 million from Medicare for NPWT pumps (E2404) in 2014, according to the HME Databank. Total Medicare spending on that code was about $88.5 million that year.

    Providers get relief from WOPD requirement

    WASHINGTON – The DME MACs have clarified that a provider must obtain a five-element order prior to delivering equipment and a detailed written order prior to billing, according to AAHomecare. “Note the change to allow a DWO to be obtained before billing,” the association stated. AAHomecare then requested clarification on the denials and appeals currently in the system based on previous guidance that a WOPD does not meet the DWOPD requirement. The response from the MACs: “Changes in policy guidance are effective for dates of service on or after the article’s publication unless otherwise specified in that article.” AAHomecare’s take: “This would mean that the appeals process needs to be used for any claim previously denied.” Overall, the association says, “This development is good news for the HME community and provides some relief related to WOPD requirements.”

    NFIB steps forward in support of H.R. 5210

    WASHINGTON – The National Federation of Independent Business has written a letter in support of H.R. 5210, a bill that would delay the second round of Medicare reimbursement cuts scheduled for July 1. “This legislation…is critical to providing the certainty necessary for America’s small suppliers and providers to continue to meet the needs of the communities who depend on their services,” the letter states. The NFIB is a non-profit organization that represents 325,000 small and independent business owners nationwide. In April, NFIB wrote a similar letter in support of S. 2736.

    Sleep group asks Oklahoma to reconsider CPAP coverage

    OKLAHOMA CITY – The American Academy of Sleep Medicine is urging the Oklahoma Medicaid program to reinstate coverage for sleep studies and CPAP devices for adult patients. Although the Oklahoma Health Care Authority has indicated it recognizes the benefits of sleep therapy, it cited a severe budget crisis in its decision to eliminate coverage for what it considers “optional” services, according to a press release from AASM. “These cuts will lead to increased medical expenses over time because they make it impossible to diagnose and effectively treat Medicaid patients who have obstructive sleep apnea and other sleep disorders, including narcolepsy, REM sleep behavior disorder, and central sleep apnea,” said Vikas Jain, MD, a board-certified sleep medicine physician who practices in Oklahoma City, in the release.

    NSM buys Wolf Medical

    FRANKLIN, Tenn. – National Seating & Mobility, which has been put up for sale by its private equity firm owner, has acquired Wolf Medical, a Rome, Ga.-based provider of complex rehab and customized mobility products. Wolf Medical’s six-person staff, including owner and ATP Gary Quellet, will join NSM. “It has gotten harder and harder over the years for us to help people and to get their feedback,” he said in a press release. “Being part of NSM will give all of us the support and resources we need to get into the community and do what we do best.” Also on staff: another experienced ATP, two service technicians, a processor and a customer service representative. With Wolf Medical’s presence in North Georgia, NSM will be able to further grow its presence in the mid-South, according to the release. It will continue to operate out of Wolf Medical’s location.

    ResMed announces positive results from study

    FLORENCE, Italy – A new study shows adaptive servo-ventilation therapy results in significant improvement in the primary endpoint for people with heart failure with preserved ejection fraction who have sleep disordered breathing, ResMed has announced. “These results are important because they are the first to show that addressing sleep-disordered breathing with ASV therapy may improve cardiovascular outcomes for people with preserved ejection fraction heart failure,” said Glenn Richards, ResMed’s chief medical officer. The results of this second-phase trial were presented by Christopher O’Connor, M.D., the investigator of the study and CEO and executive director of the Inova Heart and Vascular Institute, at the European Society of Cardiology’s 2016 Annual Heart Failure Congress on May 22. The multi-center, randomized controlled trial assessed whether the treatment of moderate to severe sleep-disordered breathing with adaptive servo-ventilation therapy could improve cardiovascular outcomes in patients who were hospitalized for a sudden worsening of their heart failure symptoms over six months. The overall study results were neutral, but an analysis showed statistically significant improvement in this pre-specified subgroup.

    Universal Software Solutions has ‘direct connection’ with McKesson

    DAVISON, Mich. – Universal Software Solutions has added a new product availability feature, streamlining ordering for HME providers. The VendorLink companion to its HDMS allows providers to quickly place orders with McKesson Medical-Surgical, decreasing handling and warehousing costs, and eliminating re-keying and data entry orders, the software vendor says in a press release. “This new integration is a direct connection into the McKesson information system and provides instant information for the user to make decisions faster,” said Christopher Dobiesz, president of Universal Software Solutions. Specifically, the integration provides a real-time “quality on hand” option, telling the provider the status of each product, the inventory levels and the quoted ricing. The VendorLink companion is available to any provider engaged with McKesson and its drop-shop program.

    Wheel:Life gets in the zone

    CHICAGO – Wheel:Life will act as a facilitator at the new “Abilities Meet Up Zone” at the Chicago Abilities Expo June 24-26. “In the tradition of a town square, the zone will be a dedicated area on the show floor where attendees can engage with their peers, experience the Expo more fully, and enjoy deeper connections as they learn from and share with exhibitors and other experts in the vibrant disability community,” Wheel:Life states in a press release. Lisa Wells, founder of Wheel:Life, and her team will act as facilitators, making introductions, sparking conversations and getting like-minded people to share experiences. The zone will include a photo booth area for people to take their pictures and share them on social media using the hashtag #AbilitiesChicago.

    3B Medical, Somnoware partner up

    WINTER HAVEN, Fla. – 3B Medical and Somnoware will integrate to allow enhanced sharing of compliance data, and to offer the ability to customize activities/alerts based on compliance and diagnostic data. With a comprehensive view of 3B Medical's sleep data and a single point of access to patient information in one unified platform, providers can use Somnoware’s analytics to easily achieve the detailed outcome measurement and reporting required. The integration project is expected to be completed by the end of July.

    PHS employee retires on high note

    ST. PAUL, Minn. – Sandi Maguire, the former managing director of home care nursing for Pediatric Home Service, has been honored as Minnesota’s Home Care Person of the year. Maguire, who retired May 13, has been with PHS since its inception in 1990. “Sandi has played an integral role in making home care what it is today in the state of Minnesota,” said PHS President Mark Hamman. “Her involvement from the very early days of home care, when it was rarely even considered an option, helped to make PHS the innovative company it is and continues to be today.”

    Ombudsman to hold roundtable

    CRANBERRY TOWNSHIP, Pa. – The Office of the National Ombudsman will host a roundtable here on June 3 to give small business owners a chance to speak about regulatory issues, like competitive bidding, that have had a negative impact. A similar roundtable was held in March in Cheyenne, Wyo. The roundtable is free but registration is required, and seating is limited.

    Short takes: Benzer, National Sleep, DMERX, Munson

    Benzer Pharmacyhas launched www.benezermedicalequipment.com to offer convenience for customers. The Tampa, Fla.-based pharmacy’s offerings include aids to daily living, back and neck therapy, beds and accessories, diabetes care and wheelchair accessories…National Sleep & Respiratory has become an in-network provider with Tufts Health Plan. The Concord, N.H.-based provider holds competitive bidding contracts for respiratory products that will allow it to service Massachusetts, New Hampshire, Vermont and Maine…PMDRX has changed its name to DMERX to reflect its expanded exam and documentation offerings. The Glendale, Ariz.-based company has also added an orthotic exam and documentation component…Munson Home Medical Equipment will hold a grand opening at its new location in Cadillac, Mich., on June 7. The provider will offer a variety of HME, including beds, wheelchairs, oxygen equipment, CPAP devices and more.


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  • 05/31/16--08:12: CQRC: Slow down bid program
  • 05/31/2016
    HME News Staff

    WASHINGTON – The Council for Quality Respiratory Care says the findings of a recent Office of Inspector General report further demonstrate the need to slow down the national rollout of Medicare’s competitive bidding program.

    “Federal policymakers should carefully evaluate the risk for implementing cuts too fast and take measures to ensure access to quality patient care is prioritized and protected,” said Dan Starck, chairman of the CQRC, a coalition of home respiratory therapy providers and manufacturers. “We know that high quality home respiratory care keeps patients at home and out of emergency rooms, hospitals and other institutional care settings.”

    Medicare is poised to implement a second round of reimbursement cuts in non-bid areas on July 1. The first round of cuts—25%, on average—went into effect Jan. 1.

    The OIG found that 43% of the 146 providers they audited had not met state licensure requirements for at least some of the competitive bidding contracts they received. Additionally, it was unclear whether or not an additional 14 providers, or 9.6%, met the requirements.

    “Considering that nearly half of the suppliers that were awarded contracts had not met basic state licensure requirements, we have significant concerns with the integrity of the competitive bidding rate setting process,” Starck said. “The fact that unqualified suppliers’ bids were used to set rates means that the current rates are not correct, and applying them to non-competitive bidding areas could create serious problems.”

    Industry stakeholders have bills in the House of Representatives and in the Senate to delay the implementation of the second round of cuts until at least Oct. 1, 2017.


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  • 06/03/16--10:10: Managers or ministers?
  • Court holds HME providers to higher degree of accountability
    06/03/2016
    Liz Beaulieu

    SAN FRANCISCO – The Ninth Circuit Court of Appeals has upheld a judge’s decision to give an HME provider charged with alleged Medicare fraud a stiffer sentence.

    The Ninth Circuit Court, in a recent 2-1 decision, agreed that a California federal judge rightly applied an “abuse-of-trust enhancement” when sentencing husband-and-wife team Patrick Sogbein and Adebola Adebimpe to prison terms of 144 months and 51 months, respectively.

    “We hold that medical equipment suppliers can have the requisite ‘professional or managerial discretion’ for the abuse-of-trust adjustment to apply,” the two affirming judges wrote. “They are responsible for determining the need for the equipment they provide and personally certify the validity of their claims to Medicare.”

    As part of a scheme that spanned years, Sogbein and Adebimpe allegedly enlisted the help of Dr. Edra Calaustro to refer patients to their companies, Debs Medical Distributors in Van Nuys, Calif., and Dignity Medical Supply in Santa Clara, Calif. In turn, they allegedly paid Calaustro, who made the referrals without performing the required medical exams, $100 per prescription.

    All told, from December 2006 through July 2011, the couple was paid more than $1.6 million for more than 400 allegedly fraudulent power wheelchair claims.

    Healthcare attorney Jeff Baird says the decision to apply the “abuse-of-trust enhancement” to an HME provider—an adjustment historically applied only to “white coat” professionals like physicians—puts them further on the hook.

    “To impose the ‘abuse of trust’ standard on a DME supplier conveys the message that DME suppliers will be held to a higher degree of accountability if they certify a need for equipment,” said Baird, chairman of the Health Care Group at Brown & Fortunato.

    The sole dissenting judge argued unsuccessfully that the application of the “abuse-of-trust enhancement” in this case mischaracterizes the role of the HME provider.

    “In my view, DME suppliers do not exercise substantial professional or managerial discretion within Medicare’s reimbursement scheme because Medicare’s rules and regulations confine them to a ministerial role and leave all critical determinations of medical need to the beneficiary’s physician,” the judge wrote.


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    06/03/2016
    HME News Staff

    WASHINGTON – The Council for Quality Respiratory Care says the findings of a recent Office of Inspector General report further demonstrate the need to slow down the national rollout of Medicare’s competitive bidding program.

    “Federal policymakers should carefully evaluate the risk for implementing cuts too fast and take measures to ensure access to quality patient care is prioritized and protected,” said Dan Starck, chairman of the CQRC, a coalition of home respiratory therapy providers and manufacturers. “We know that high quality home respiratory care keeps patients at home and out of emergency rooms, hospitals and other institutional care settings.”

    Medicare is poised to implement a second round of reimbursement cuts in non-bid areas on July 1. The first round of cuts—25%, on average—went into effect Jan. 1.

    The OIG found that 43% of the 146 providers they audited had not met state licensure requirements for at least some of the competitive bidding contracts they received. Additionally, it was unclear whether or not an additional 14 providers, or 9.6%, met the requirements.

    “Considering that nearly half of the suppliers that were awarded contracts had not met basic state licensure requirements, we have significant concerns with the integrity of the competitive bidding rate setting process,” Starck said. “The fact that unqualified suppliers’ bids were used to set rates means that the current rates are not correct, and applying them to non-competitive bidding areas could create serious problems.”

    Industry stakeholders have bills in the House of Representatives and in the Senate to delay the implementation of the second round of cuts until at least Oct. 1, 2017.

    Accessibility groups wrangle over specifics of bill

    WASHINGTON – The Independent Auto Lift Dealers of America has appealed to lawmakers to tweak a bill in the House of Representatives, as well as a companion bill being considered in the Senate, that seeks to improve the provision of automobiles and adaptive equipment by Veterans Affairs. In a May 19 letter to the chairman of the Senate’s Committee of Veterans Affairs, the group said the bill, H.R. 3471: “needs a more robust conflict-of-interest provision related to the use of a third-party certification organization for the new safety standards.” The Independent Auto Lift Dealers of America says the National Mobility Equipment Dealers Association drafted the bill as part of its campaign to become designated as the VA’s third-party certification organization. That’s unfair, the Independent Auto Life Dealers of America says, because NMEDA is dominated by three large national chains. The group says the bill should be tweaked to better differentiate between simple and complex modifications to ensure that exterior lifts that don’t affect the operation of or alter the structure of the vehicle may continue to be installed at home.

    Option Care awarded enteral contracts

    BANNOCKBURN, Ill. – Option Care has accepted contracts in the Round 2 re-compete to provide enteral nutrition services across the country. The provider has participated in the competitive bid program since 2011. “Our continued selection by CMS demonstrates that Option Care is a partner of choice because our proven track record of delivering quality care ensures successful outcomes,” said John Rademacher, COO for Option Care. “Our high rates of patient satisfaction and safety demonstrate that we put patients at the center of our personalized, compassionate approach to care.” Option Care is one of the largest providers of home and alternate site infusion services, with more than 1,800 clinicians.

    Cape Medical launches new phone system

    SANDWICH, Mass. – Cape Medical Supply has implemented an Internet-based phone system in partnership with ShoreTel Connect. The new system will reduce wait times, and result in direct department access and more efficient customer service. “As we continue to grow and expand our reach across New England, we needed to invest in our future and invest in our continued improvement as a company so we can scale our industry-leading patient care programs," said Gary Sheehan, president and CEO of Cape Medical Supply. ShoreTel Connect will eventually be integrated with the company’s email system of offer web-based support to its customers.

    U.S. Rehab, TiLite partner up

    WATERLOO, Iowa – U.S. Rehab and Permobil have announced that TiLite will be a contracted supplier of titanium and aluminum manual wheelchairs for members of U.S. Rehab. “Our mutual interests in patient outcomes are what brings this synergy,” said Greg packer, president of U.S. Rehab. “This relationship with another high quality manufacturer like TiLite is a big win for U.S. Rehab members all over the country.” Permobil acquired TiLite in 2014.

    Groups promote ‘Get Out & Enjoy Life’ contest

    ATLANTA – Sports ‘n Spokes, the sports and recreation magazine of the Paralyzed Veterans of America, has teamed up with Wheel:Life, a social community for wheelchair users, to promote the “Get Out & Enjoy Life This Summer” photo contest and prize giveaway. The social media pages of Sports ‘n Spokes and Wheel:Life will feature daily listings of accessible vacation spots, outdoors programs and other events to encourage wheelchair users to participate in the contest, now in its sixth year. The first place winner will receive a Panthera X carbon fiber wheelchair valued at $11,000 courtesy of Triumph Mobility, a “Get Out & Enjoy Life” prize pack and, depending on the quality of the photo submitted, the cover of the September issue of Sports ‘n Spokes.

    Drive DeVilbiss adds fourth distribution center

    PORT WASHINGTON, N.Y. – Drive DeVilbiss Healthcare will open a 232,000-square-foot distribution center in Indianapolis on June 1 to meet growing demand for its products. “We will continue to optimize our supply chain to provide better value and improved service levels to our customers,” said Harvey Diamond, CEO of Drive DeVilbiss, in a press release. Similar to existing centers in South Brunswick, N.J., Atlanta and Rialto, Calif., the center features the latest in automation to ensure orders are processed, picked and shipped quickly and accurately. It will house the entire Drive DeVilbiss product line.

    Circadiance ready to rebrand

    EXPORT, Pa. – Circadiance has received a scope extension to its ISO 13485 Certificate and CE Marketing for its SmartMonitor and NeoPAP product lines, the company announced June 1. These approvals allow Circadiance to complete the rebranding of the product lines to fully capitalize on the interest of several international distributors. Circadiance acquired the SmartMonitor and NeoPAP product lines, including the infant apnea monitoring and PAP technologies associated with them, from Philips Respironics last year.

    Point of Rental impacts revenues

    GRAND PRAIRIE, Texas – Point of Rental Software, a provider of rental and inventory management software, has completed a study of the impact that online orders are having on rental business revenues. One client reported that first quarter earnings were up about 30% after implementing Point of Rental Essentials, a cloud-based product for rental and inventory needs. The product allows businesses to provide their customers with a 24/7 view of availability, and get quotes and reserve items. It also features a portal where they can access their accounts, view orders, cancel bookings and make secure payments online.

    Short takes

    Exeter, Pa.-based Quantum Rehab has continued its partnership with the ALS Association. As a premier-level national partner, the company supports ALS Association events, including the Walk to Defeat ALS. Chapters of the association have the opportunity to collaborate with Quantum’s national network for the Walk and other events…Goleta, Calif.-based Inogen has gone to market with the Inogen One G4 portable oxygen concentrator. The G4 is the company’s smallest and lightest POC at 2.8 pounds…ResMed has received clearance from the Food and Drug Administration for the iVAPS therapy mode for its Astral life support ventilators. ResMed’s Astral life support ventilators offer mobility and ease of use for patients suffering from neuromuscular disease, COPD, and other adult and pediatric breathing disorders...Pride Mobility Products has been granted a patent for “Elevated Height Wheelchairs” relating to its Quantum iLevel, Jazzy Air and corresponding power seat elevation technologies. Specifically, the patent addresses safer performance of a power elevating seating system in conjunction with power base operation.

    People news

    Michael Petras, formerly president of Cardinal Health’s Post-Acute Solutions businesses, has been named CEO of Sterigenics International. Sterigenics is a provider of contract sterilization, gamma technologies and medical isotopes, and is a portfolio company of Warburg Pincus and GTCR. Petras succeeds Michael Mulhern, who has been appointed executive chairman of the company’s board of directors. Before Cardinal Health, Petras was the CEO of AssuraMed, which Cardinal bought for about $2 billion in 2013.


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  • 06/08/16--09:43: OIG issues mid-year update
  • 06/08/2016
    HME News Staff

    WASHINGTON – Power mobility devices and orthotic braces are among the product categories under review by the Office of Inspector General, according to a new report.

    The OIG released its Mid-Year Update for 2016 on June 7.

    Necessary and compliant

    The OIG will perform several reviews to determine whether claims were medically necessary and compliant with Medicare requirements. Affected product categories include orthotic braces, nebulizers and related drugs, and power mobility devices.

    System edits

    The OIG will conduct a review to determine the effectiveness of system edits to prevent inappropriate payments for diabetes test strips and lancets to multiple suppliers. Prior OIG work found that inappropriate payments were made to multiple suppliers for test strips and lancets dispensed to the same beneficiary with overlapping service dates.

    Power mobility devices

    The OIG will conduct a review to determine whether potential savings can be achieved if certain power mobility devices are rented over 13 months rather than acquired as a lump-sum purchase. The Affordable Care Act eliminated the lump-sum purchase option on Jan. 1, 2011, but only for standard power wheelchairs.

    Ventilators

    The OIG will describe billing trends for vents, respiratory assist devices and CPAP machines from 2011 to 2014, and examine factors associated with the increase in billing for vents. The OIG will also examine the impact of the competitive bidding program on billing trends for vents.

    Competitive bidding

    The OIG will also perform a mandatory review of CMS’s competitive bidding process.


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    06/10/2016
    HME News Staff

    WASHINGTON – A bill in the House of Representatives that would delay a second round of Medicare reimbursement cuts slated for July 1 has gained 18 additional co-sponsors in the wake of the AAHomecare Washington Legislative Conference, May 25-26. The total for H.R. 5210 now stands at 97. Additionally, the bill’s sponsor, Rep. Tom Price, R-Ga., testified June 8 at a House Ways & Means Health Subcommittee hearing on “Legislation to Improve and Sustain the Medicare Program.”“Patients' lives are literally at risk,” he told the committee of the bid program’s impact. A Senate companion bill, S. 2736, has 29 co-sponsors.

    FMCSA extends comment deadline on sleep rule

    WASHINGTON – The Federal Motor Carrier Safety Administration and the Federal Railroad Administration have extended the public comment period on the potential impact of requiring sleep-apnea tests for commercial drivers and rail workers. The comment period has been extended from June 8 to July 8, 2016. The two groups announced in March that they were seeking input on the proposal and have hosted comment sessions in Washington, D.C., Chicago and Los Angeles.

    OIG issues mid-year update

    WASHINGTON – Power mobility devices and orthotic braces are among the product categories under review by the Office of Inspector General, according to a Mid-Year Update for 2016 released by the Office of Inspector General on June 7. The OIG will perform several reviews to determine whether claims were medically necessary and compliant for orthotic braces, nebulizers and related drugs, and power mobility devices. The OIG will also conduct a review to determine the effectiveness of system edits to prevent inappropriate payments for diabetes test strips and lancets to multiple suppliers. The OIG will also conduct a review to determine whether potential savings can be achieved if certain power mobility devices are rented over 13 months rather than acquired as a lump-sum purchase (The Affordable Care Act eliminated the lump-sum purchase option on Jan. 1, 2011, but only for standard power wheelchairs). Additionally, the OIG will describe billing trends for vents, respiratory assist devices and CPAP machines from 2011 to 2014, and examine factors associated with the increase in billing for vents. Also on the OIG’s docket:It willperform a mandatory review of CMS’s competitive bidding process.

    Metamason draws $3M in funding

    LOS ANGELES – Metamason, the company behind a 3-D scanned and printed customized CPAP mask, has closed on a $3 million Series Seed financing round. The investment was led by 3P Equity Partners, a manufacturing-focused private equity firm in San Jose, Calif., and Tsing Capital, a leading “cleantech” venture capital firm in China. “We are thrilled to reach this important milestone for the company,” said CEO Leslie Oliver Karpas. “Our investors are confident that Metamason will be a disruptive, positive force in the $4 billion global sleep apnea market.” Metamason plans to use the investment to complete regulatory clearance with the U.S. Food and Drug Administration and to run initial clinical trials for its patent-pending flagship product, Respere. Also on the horizon: a crowdfunding campaign later in 2016 and marketing activities in early 2017. Metamason expects to make Respere publicly available in the second quarter of 2017.

    Senior Medicare Patrol projects see mixed results

    WASHINGTON – Senior Medicare Patrol projects report $2.5 million in expected recoveries for Medicare in 2015, compared to $660,829 in 2014, a 282% increase, according to a June 3 report from the Office of Inspector General. These projects did not report any expected recoveries for Medicaid in 2015, compared to $504 in 2014. The Senior Medicare Patrol projects also reported $35,059 in savings to Medicare beneficiaries and others in 2015, compared to $80,228 in 2014, a 56% decrease. These projects also reported $21,533 in cost avoidance for Medicare, Medicaid, beneficiaries and others in 2015, compared to $200,598 in 2014, an 89% decrease. While the Senior Medicare Patrol seemed to be less successful in certain areas, the OIG believes the projects may not be receiving full credit for savings attributable to their work. “It is not always possible to track referrals to Medicare contractors or law enforcement from beneficiaries who have learned to detect fraud, waste and abuse from the projects,” the report states. “In addition, the projects are unable to track the potentially substantial savings derived from a sentinel effect, whereby Medicare beneficiaries’ scrutiny of their bills reduce fraud and errors.”

    VirtuOx launches DocViaWeb

    WASHINGTON – VirtuOx, a national sleep and respiratory testing provider, has launched a sister company, DocViaWeb, to provide HIPAA-compliant and cost-effective telemonitoring solutions for healthcare organizations and professionals to diagnose and treat at home. DocViaWeb specializes in two healthcare verticals: sleep disorders and home health care. The sleep disorders program provides the ability to test for sleep apnea in real time, using advanced diagnostic sleep medicine tools, and to schedule online consultations with board-certified sleep specialists. It also provides the ability to coordinate APAP or oral appliances through DME providers. The home health care program provides outsourced transitional care management and chronic care management using VirtuOx’s proprietary software, CareCentered.

    Contour: 25 years, 20 million sold

    CHARLOTTE, N.C. – Contour Products is marking two milestones: 25 years in business and 20 million units sold. The company is ramping up outreach to doctors and respiratory therapists to further promote its CPAP pillow line, including a “Contour Referral Program” offering helpful information, samples and promotional opportunities. “The importance of respiratory therapists and other medical professionals can’t be overstated,” said Scott Davis, president.

    Convaid supports SMA events

    TORRANCE, Calif. ­– The Pediatric Group of Etac NA will attend the Cure SMA National Conference, June 16-19 in Anaheim, Calif., as a platinum exhibitor and will donate a Convaid Trekker to kick off the event. The Pediatric Group—Convaid and R82—will also participate at Cure SMA Walk-n-Rolls throughout the United States over the course of this year. “We are steadfast advocates for families living with special needs,” said Nanneke Dinklo, marketing director for Etac NA. “We embrace opportunities to help families enjoy their freedom and live full, active lives.”


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  • 06/16/16--11:20: Calling all women leaders
  • 06/16/2016
    HME News Staff

    WATERLOO, Iowa – The VGM Group introduced the “HME Woman of the Year Award” at a special session at its annual Heartland Conference this week.

    “Women play such an important role in our industry and we want to recognize that by honoring a specific woman for the contributions she has made through leadership, patient care, best practices, advocacy or any other aspect of leadership,” said Mike Mallaro, CEO of the VGM Group.

    The new award is open to all women who work in the HME industry, VGM says.

    The announcement was made during a new session at the Heartland Conference called “Women and Wine.” The session included presentations on how to manage stress, and how to develop a community of peers to share ideas and celebrate accomplishments.

    Mallaro says the award is meant not only to highlight existing leaders but also to inspire a new group of leaders.

    “As the landscape of health care shifts, our industry requires an ‘all-hands-on-deck’ mentality and growing pool of leaders,” he said.

    VGM will announce the “woman of the year” at Medtrade this fall.


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    Second phase of cuts hits non-bid areas on July 1
    06/17/2016
    Theresa Flaherty

    WASHINGTON – Friday afternoon was a nail-biter for the HME industry as a bill that would delay a second phase of Medicare reimbursement cuts moved through the “hotline” process in the Senate.

    An unknown Republican Senate office on Friday put a hold on S. 2736, leading industry and state associations to blast urgent messages to members directing them to reach out to their senators.

    “We need a wave of immediate support,” VGM said in a bulletin. “The clock is literally ticking for this bill to have a chance of being passed.”

    At press time, there were still many unanswered questions, including whether the hotline process had also been initiated on the Democrat side of the Senate, and what the hard deadline for passing the bill is, first thought to be 5 p.m. Friday.

    “We’ve also heard that the process can go into (the week of June 20),” said Cara Bachenheimer, senior vice president of government relations for Invacare.

    If the bill passes the Senate, it will move to the House of Representatives for a vote under suspension.

    Introduced March 17 by Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.C., the bill seeks to delay the second phase of cuts in non-bid areas for 15 months—from July 1, 2016, until Oct. 1, 2017. However, a recent Congressional Budget Office score of the bill reduced the delay to 12 months.

    That still buys the industry and its champions time to get a more permanent fix to the program, say stakeholders.

    “This will get us into next year, where there will be a larger Medicare bill,” Jay Witter, senior vice president of public policy for AAHomecare, told attendees at the VGM Heartland Conference last week.“Once that second round cut happens, it will be extremely difficult to move forward.”

    Although July 1 is less than two weeks away, CMS has yet to release the new payment rates, which may be even lower than what the industry has anticipated, say stakeholders.

    “We all assumed the rate cut would double, however CMS has said it would (incorporate the reduced single payment amounts implemented Jan. 1 into the new SPAs),” said Bachenheimer. “It’s further manipulation by CMS of the bid prices.”


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    ‘After three days…(attendees) said they felt optimistic’
    06/17/2016
    Theresa Flaherty

    WATERLOO, Iowa – Igniting ideas and cultivating connections was the ever-positive theme at last week’s Heartland Conference, now in its 15th year.

    “The energy level was high, and there was great engagement and thought-provoking conversations from vendors and members,” said Clint Geffert, president of VGM & Associates. “During one of the final sessions, on the last day, we asked attendees to give one word about how they felt after three days of networking and education, and they said they felt optimistic, empowered, inspired, encouraged and comfortably refreshed—which is precisely what we strive for.”

    The Heartland Conference, held June 13-16, drew nearly 1,000 attendees from across the country, according to VGM. It featured more than 100 educational sessions across 10 tracks, and 71 exhibitors.

    New mindset

    Attendees were urged to position themselves to take advantage of a shift in behavior that sees consumers, more than ever, going online to find information and products quickly.

    That’s going to ratchet up quicker than you think, said Google’s Josh Weum, during a session titled, “Micro Moments—How Our Biggest Opportunities are Found in the Smallest Moments.”

    “It’s going to be overnight, when the elderly get online, and we are very close to that integration,” Weum told attendees. “You want to be there when they get there—that’s when you have that impact. The Internet is happening yesterday.”

    Overdue recognition

    Women are often under-recognized in business, and the VGM Group is taking a step toward fixing that this year.

    During a special session, “Women and Wine: Celebrating the Women of HME,” VGM announced “The HME Woman of the Year Award.”

    “Women play such an important role in our industry and we want to recognize that by honoring a specific woman for the contributions she has made through leadership, patient care, best practices, advocacy or any other aspect of leadership,” said Mike Mallaro, CEO of the VGM Group.

    New beginningsThis year’s Heartland Conference was the first without VGM founder Van Miller, but his presence was there—most notably in the form of his former dog, Daisy, who is now training with Retrieving Freedom to become a service dog for a veteran. Through raffle tickets and donations, attendees raised $2,114 for the organization, a nonprofit that trains service dogs and matches them with families.


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    06/17/2016
    HME News Staff

    SAN DIEGO – Remote monitoring and automated coaching from ResMed significantly improve the use of CPAP therapy for patients with obstructive sleep apnea, according to an independent study presented last week at the SLEEP conference in Denver. As part of this largest-ever, randomized, controlled study on OSA in the United States, more than 500 patients on CPAP therapy received support, including remote monitoring and automated coaching from ResMed’s U-Sleep platform. Those who received support from U-Sleep achieved Medicare-defined adherence 21% more than the average study participant over a 90-day period, the study found. “Anything that significantly increases CPAP use in the first 90 days is a big deal,” said Dr. Dennis Hwang, a sleep specialist at Kaiser Permanente’s Fontana Medical Center and the study’s principal investigator. “That initial period is crucial for patients to embrace CPAP to treat their sleep apnea, which is linked to heart failure, atrial fibrillation, Type 2 diabetes and other serious conditions. Tools like U-Sleep hold a lot of promise for patients on CPAP and the clinicians who treat them.” The U-Sleep patient management platform provides individualized feedback via text, email or phone based on CPAP use.

    Philips Respironics improves adherence with new service

    MURRYSVILLE, Pa. – Philips Respironics has launched Patient Adherence Management Service, a connected management solution using cloud-based data to support treatment adherence for sleep and respiratory patients. PAMS marries the company’s EncoreAnywhere software, DreamStation PAP therapy devices, its portfolio of masks and DreamMapper patient engagement application with a new Patient Outreach Protocol to boost adherence rates up to 24% within the first 90 days, the company says. “With this new connected management service, our goal is to help patients fully engage with and adapt to their therapy, ultimately helping them live healthier lives,” said Dr. Mark Aloia, vice president and global lead, behavior change for Philips, a speaker at this week’s SLEEP conference in Denver. The Patient Outreach Protocol includes personalized calls, emails and texts to deliver education, motivational reminders and support from sleep coaches and respiratory therapists.

    Mediware release amps up retail capabilities

    LENEXA, Kan. – The next release of Mediware’s CareTend will enable HME and home infusion providers to grow their retail operations. The release’s point-of-sale capabilities give providers the tools they need to quickly process transactions using their own hardware. The POS system is scalable for single and multi-site operations, so providers can see all transactions, inventory items and sales, regardless of location. Transactions are processed using barcode scanning and multiple forms of payment are accepted.

    Universal Software steps up partnership with Vantiv

    DAVISON, Mich. – Universal Software Solutions has enhanced its partnership with Vantiv Integrated Payments. Universal Software has made a fully integrated EMV (Europay, MasterCard and Visa) U.S.-based processing solution with a Vantiv processing platform available for its Healthcare Management Data System (HDMS). Customers will benefit from chip card payment solutions and services, and advanced security products and reporting tools. “We’re thrilled to work with USS to help make the healthcare payments ecosystem more secure and keep cardholder data safe,” said Matt Downs, head of business and channel development integrated payments at Vantiv. The enhancement will be available in the third quarter of 2016. Universal Software and Vantiv have been partners since last summer.

    Early registration opens for Medtrade

    ATLANTA – Early registration for Medtrade opens Monday. “We are preparing a show that is designed to help providers deal with changing times,” said Kevin Gaffney, group show director. “Early registration is the first step toward making your plans to find the solutions you need.” Early registration gets attendees $75 off the trade show floor and $200 off the conference program. Medtrade, the HME industry’s biggest trade show, is set for Oct. 31-Nov. 3 at the Georgia World Congress Center in Atlanta. To register, go to www.medtrade.com.

    Lab Tactical redesigns newsletter

    ATLANTA – Lab Tactical has redesigned its “Lab Notes” email newsletter for HME providers. Now called “The Renaissance Provider,” the free newsletter will focus on sharing news about profitable, patient-centered solutions for HME businesses. The first edition includes tips on “How do I transition to an outcomes-driven clinical model?” Among the answers: replace the word outcome with value, and treat compliance criteria like a yield sign in your billing process.

    Short takes

    Pittsburgh-based Circadiance has launched the SleepWeaver Advance pediatric soft cloth CPAP mask. The company recently received FDA clearance to market the mask in the United States, after launching the product in Europe several months ago. The mask is making its debut at the SLEEP conference this week in Denver…Sioux City, Iowa-based Mercy Home Medical Equipment has appointed Micah Bonderson as manager. Bonderson was previously a branch manager for Avera Home Medical Equipment in LeMars, Iowa. He also has experience as a respiratory therapist…An Aquatec OceanDual shower chair from Oakdale, Pa.-based Clarke Health Care Products was selected and used by Dr. Stephen Hawking during this recent trip to New York to promote a new project. The chair, which features tilt-in-space and recline positioning and matches a chair Hawking uses at home, was transported to various hotels during his stay. National Seating and Mobility in Garden City, N.Y., arranged the purchase and delivery of the chair…The use of absorbent briefs with curly fiber significantly lower/acidify skin pH, reducing the risk for incontinence-associated skin damage, according to a study announced by Hartmann, a Rock Hill, S.C.-based manufacturer of incontinence, wound care and compression therapy products. The study was led by Donna Bliss, a renowned incontinence researcher and professor at the University of Minnesota School of Nursing.


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    July 1 pricing factors in Round 2 re-compete pricing, making cuts even steeper
    06/23/2016
    HME News Staff

    WASHINGTON – CMS late this afternoon released new pricing for non-competitive bidding areas as of July 1, and in one fell swoop handed down cuts of anywhere from 10% for insulin pumps to 80% for TENS units compared to pricing in 2015.

    Among 15 products highlighted in a CMS fact sheet, 11 show cuts of 50% or more, AAHomecare pointed out in a bulletin.

    “It’s clear that these are cuts that will be devastating for providers and patients alike in these areas, and ultimately unsustainable for a healthcare infrastructure serving the needs of a growing senior population, as well as people with disabilities and chronic conditions who depend on HME,” the association stated.

    CMS implemented a first round of cuts in non-bid areas, averaging about 25%, on Jan. 1.

    The agency did, as stakeholders suspected it would, factor in new pricing for the Round 2 re-compete into the July 1 pricing, making the cuts even steeper.

    The new pricing comes just as the industry was with one hand celebrating the Senate passing a bill that would delay this second round of cuts for one year and with the other hand decrying a sit-in in the House of Representatives over gun control that prevented a similar bill from passing there.

    AAHomecare says there “may be a chance” to move forward after Congress returns from its July 4 recess, with a bill that would retroactively stop the July 1 pricing.

    “We are also working with other parties in the Senate and in the administration to directly ask CMS to delay the cuts until legislation can be considered,” it stated.


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    06/23/2016
    HME News Staff

    WASHINGTON – The Senate has passed a bill that would delay a second round of Medicare reimbursement cuts, according to the Council for Quality Respiratory Care.

    Medicare plans to implement a second round of cuts in non-bid areas on July 1, following a first round of cuts that went into effect in those areas on Jan. 1. Together, they will reduce reimbursement, on average, 50%.

    “We applaud the Senate for recognizing the urgency in passing this legislation before July 1, which will help to ensure that patient care is not jeopardized as a result of these Medicare cut,” said Dan Starck, chairman of the CQRC in a press release.

    S. 2736, introduced by Sens. John Thune, R-S.D., and Heidi Keitkamp, D-N.D.,would delay the second round of cuts for one year, until July 1, 2017.

    CQRC strongly urges the House of Representatives to follow the Senate’s lead and pass a companion bill, H.R. 5210. The bill has 116 co-sponsors.


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    06/23/2016
    HME News Staff

    WASHINGTON – A $900-million takedown by the Medicare Fraud Strike Force on June 22, the largest in history, included schemes involving durable medical equipment.

    The nationwide sweep resulted in criminal and civil charges against 301 individuals, including 61 doctors, nurses and other licensed medical professionals, for alleged false billings.

    “As this takedown should make clear, healthcare fraud is not an abstract violation or benign offense—it is a serious crime,” said U.S. Attorney General Loretta Lynch, who announced the takedown with Department of Health and Human Services Secretary Sylvia Burwell. “The Department of Justice is determined to continue working to ensure that the American people know that their healthcare system works for them—and them alone.”

    The individuals have been charged with various healthcare fraud-related crimes, including conspiracy to commit healthcare fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft. The crimes involve various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment and prescription drugs.

    In the Southern District of California, five individuals, including a doctor and pharmacist, were charged in a scheme to pay bribes and kickbacks to doctors in exchange for prescribing durable medical equipment and compound pain creams that were not medically necessary. The indictment alleges that, in this case alone, about $27 million in false and fraudulent claims were submitted.

    The cases are being prosecuted and investigated by U.S. attorneys offices nationwide.

    Including these most recent actions, nearly 1,200 individuals have been charged in national takedown operations, which have involved more than $3.4 billion in fraudulent billings.


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    Discussions will resume after July 4th recess
    06/24/2016
    Theresa Flaherty

    WASHINGTON – With efforts to delay a second round of Medicare cuts stalled, the HME industry finds itself between a rock and a hard place, stakeholders say.

    “We’re regrouping and figuring out with our champions where we go from here,” said John Gallagher, vice president of government relations for The VGM Group, of the cuts set for July 1 in non-bid areas.

    A modified version of H.R. 5210 was scheduled to go to vote last week, but an unexpected sit-in by House Democrats over gun control prevented anything from getting done before Congress adjourned for the July 4th recess.

    Earlier in the week, the Senate unanimously passed its bill, S. 2736, introduced by Sen. John Thune, R-S.D.

    “We’ve got all 100 senators—that’s huge,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “Sen. Thune needs to be commended for his leadership. That’s a lot of momentum.”

    The modified House bill, which was met with some behind-the-scenes resistance over the proposed Medicaid pay-for, would delay the second round of cuts for three months, compared to 12 months in the Senate bill.

    “It’s three months, but with the promise to extend it beyond that,” said Bachenheimer.

    Having different versions of bills complicates things, stakeholders say.

    “Once the House comes back, can they move quickly on the Senate bill with the different pay-for?” said Gallagher. “There’s lots of options in flux, and there will be lots of discussions when they get back.”

    One talking point stakeholders will be bringing up: the new pricing set to go into effect July 1, which CMS released June 23, after Congress adjourned. The cuts factor in Round 2 re-compete pricing and range from 10% for insulin pumps to 80% for TENS units.

    “We need to showcase that,” said Gallagher. “The rates are drastically lower than even we expected, and CMS knows that Congress is looking to make a change.”


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    06/24/2016
    Liz Beaulieu

    YARMOUTH, Maine – If a second round of Medicare reimbursement cuts goes into effect as planned, a number of HME providers plan to stop taking assignment on certain products.

    “There’s a high likelihood that we’ll go unassigned on a lot of things,” said Amy Schmidt, a partner at Midwest Medical in Watertown, S.D. “We can’t afford to do a lot of what we do at these decreased rates.”

    Medicare already reduced reimbursement by about 25% in non-bid areas on Jan. 1. It plans to cut reimbursement by at least the same amount again on July 1.

    Schmidt says her company was able to “accommodate” the first round of cuts by limiting employee perks, eliminating advertising, adjusting insurance and making other changes. But she predicts the second round of cuts will push her company and a flood of others to stop taking assignment.

    “So many providers are going to do this that the beneficiary is going to have to find a way to pay, or choose not to take the equipment and end up in the hospital,” she said.

    Providers don’t take such a drastic move lightly, but they’re running out of ways to make their businesses work with such steep reimbursement cuts, says Rose Schafhauser, the executive director of the Midwest Association of Medical Equipment Services, which represents a number of states heavy in non-bid areas.

    “We’ve surveyed our members and this is the first route they’re going to take (on July 1),” she said. “They’re saying, ‘We have no choice if we want to stay around.’”

    Some providers even plan to make “blanket” changes, Schafhauser says.

    “Inexpensive or other routinely purchased DME like canes and crutches—they’re not going to take assignment on those across the board,” she said.

    What’s more: It’s possible that the second round of cuts will be even greater than 25%, if CMS, as some suspect, factors in the new pricing from the Round 2 re-compete that went into effect Jan. 1, which was 15% to 20% lower than the previous Round 2.

    “We’re planning on the total cut being 50%,” Schmidt said. “If it’s more than that, I don’t know what we’ll do. There are companies going out of business left and right, even companies in metropolitan areas.”

    If providers stop taking assignment en masse, it might get Medicare’s attention. The agency in May released data comparing the rate of assignment of claims for DMEPOS for the first four months of 2015, which were paid at the unadjusted fee schedule rates, and the first four months of 2016, which were paid at the new partially adjusted rates, and found providers in all areas continued to accept assignment.

    The key to determining the true impact of providers deciding to stop taking assignment will be keeping track of how many beneficiaries, as a result, refuse equipment, Schafhauser says.

    “That’s not going to show up in CMS’s numbers,” she said.

     


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