In brief: AAH comments on Stark Law, resupplies; Lincare settles

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Friday, August 24, 2018

WASHINGTON – AAHomecare emphasized the importance of coordinated care in its comments to CMS on possibly relaxing the Stark Law.

The Stark Law is designed to prevent physicians from ordering services and products for Medicare beneficiaries when the motivation is to make money.

In its comments, however, AAHomecare states that the Stark Law may “overly limit” healthcare providers—not only physicians but also HME providers, therapists (respiratory, physical and occupational), home health agencies and pharmacies—from coordinating care to treat beneficiaries more cost effectively.

“While it is important that the Medicare program encourage coordination, it is equally important that protection against fraud be maintained,” states AAHomecare. “This is a balancing act.”

AAHomecare also emphasized that a prohibition against allowing physicians to provide DME not listed in the “allowed products” category remain in place to ensure the infrastructure necessary to service beneficiaries; preserve beneficiary choice of products; and ensure accreditation standards are met.

The Department of Health and Human Services published a request for information, “Medicare Program: Request for Information Regarding the Physician Self-Referral Law” in June.

Association points to burdensome resupply requirements

AAHomecare also submitted comments to a June report from the Office of Inspector General that said most Medicare claims for CPAP supplies did not comply with requirements.

In a letter to Inspector General Daniel Levinson, the association pointed out that the local coverage determinations for CPAP are known for being one of the most complicated, with overly burdensome requirements.

While the OIG report cited proof of delivery issues in 36 out of 110 errors, AAHomecare pointed to the fact that CMS in recent months has provided guidance to allow additional flexibility. For example: The date of service on the claim can now be the ship date, the actual receipt date or the date the shipping label is printed, instead of the narrow definition of the date of service only being the ship date.

AAHomecare also suggested that the sample of 110 claims may not paint an accurate picture.

“In closing, AAHomecare would request the OIG to recommend that CMS continue to look at the overly burdensome nature of PAP supply requirements in an effort to work with the industry to ensure that beneficiaries have access to needed supplies for their sleep therapy,” it wrote.

Lincare pays $5.25M to resolve allegations

CLEARWATER, Fla. – Lincare has paid $5.25 million to resolve allegations that it violated the federal False Claims Act and the Anti-Kickback Statute by offering illegal price reductions to Medicare beneficiaries, according to the U.S. Attorney’s Office for the Southern District of Illinois. The government alleged that, from 2011 to 2017, Lincare attempted to gain a competitive advantage in the market by unlawfully waiving or reducing co-insurance, co-payments and deductibles for beneficiaries who participated in a Medicare Advantage Plan operated through a private insurer. The allegations were first brought to light in a 2015 whistleblower lawsuit filed by Brian Thomas, a former billing supervisor at Lincare, who will receive $918,750 from the settlement proceeds.

Mediware acquires Rock-Pond Solutions

LENEXA, Kan. – Mediware Information Systems has acquired Rock-Pond Solutions, a business intelligence and analytics software provider for the home infusion, home medical equipment, and specialty pharmacy industries. The deal will allow Mediware to develop better solutions for the post-acute care market. It will also support more collaborative work on Mediware’s CareTend product roadmap. “(Rock-Pond’s) highly regarded team brings deep experience in post-acute care and they have successfully helped Mediware’s CareTend software become the strong solution it is today,” said Bill Miller, Mediware CEO in a press release.

OIG finds a few overpayments, Liberty disagrees

PORT ST. LUCIE, Fla. – Liberty Medical mostly complied with Medicare requirements for inhalation drugs, according to a new report from the Office of Inspector General. The OIG sampled 100 claims and found 94 in compliance. Of the remaining six claims, the agency says Liberty did not provide medical records for four, and lacked proof of delivery for two, resulting in an overpayment of $2,408. As a result, the OIG estimated that Liberty received $47,5626 in overpayments and recommended that the provider refund the money to Medicare contractors. Liberty disagreed with the OIG’s recommendations, saying that it provided sufficient documentation to establish medical necessity, and that it provided additional proof of delivery documentation for six of eight disallowed sample claims.

VGM Fulfillment expands footprint

WATERLOO, Iowa – VGM Fulfillment has opened a resupply distribution center in Nashville, Tenn. The 40,000-square-foot warehouse is staffed with 22 existing employees who are familiar with CPAP resupply, according to a press release. “Expanding our operations to a logistics hub like Nashville allows us to route some of our resupply order volume to the new facility—ensuring that patients located in the southern and eastern United States will receive their orders even quicker, resulting in greater patient satisfaction,” said Jeremy Stolz, president of VGM Fulfillment. “We’ve experienced tremendous growth year over year. This expansion will allow us to ship more packages per day all while improving transit times.” VGM Fulfillment ships more than 2 million orders annually, and recently launched a resupply program for compression stockings.

Golden Technologies video earns honors

OLD FORGE, Pa. – Golden Technologies has been named a bronze winner in the 39th Annual Telly Awards for its product launch video for the MaxiComfort power recliner, it announced in a press release. The video was honored in both the general/home furnishings and the craft-directing for promotional video categories. “It is a credit to the huge undertaking involved in elevating our marketing to the next level, hiring talented people to help us create real product lifestyle pieces that not only inspire consumers but help us illustrate the way these products can make you feel,” said Tim Robinson, director of digital media. The Telly Awards honor excellence in video and television.

GAO sides with C2C on QIC contract

WASHINGTON – The Government Accountability Office agrees that CMS failed to properly assess “potential organizational conflict” when the agency awarded Maximus the DMEPOS QIC contract. The GAO’s decision comes after C2C Solutions, the current QIC contractor, protested the award. The GAO’s decision sustains C2C’s protest. “Protest that the agency failed to evaluate a potential impaired objectivity organizational conflict of interest is sustained where the awardee’s wholly-owned subsidiary would review decisions on appeal from the parent company’s own claims decisions, and the agency did not meaningfully consider whether this structure created an impaired objectivity organizational conflict of interest,” the GAO stated. Additionally, “protest that the agency failed to evaluate a potential unequal access to information organizational conflict of interest is sustained where the record does not demonstrate that the agency reasonably evaluated a potential unequal access to information conflict arising from the relationship between the awardee and one of its subsidiaries,” it stated.

Somnoware enhances platform

SUNNYVALE, Calf. – Somnoware, a provider of digital health software, has launched an enhanced DME-ordering capability for enterprise healthcare systems. The expanded interoperability with electronic medical record or EMR software enables customers to manage patients who have historically not been on the platform. “This will allow enterprise healthcare systems to rapidly deploy Somnoware across all their facilities without changing their existing processes, resulting in improved care coordination and reduced costs,” the company states. With the enhanced DME ordering capability, physicians and care providers can now place orders within their existing EMR system. The order is then transmitted automatically via Somnoware to the DME company for fulfillment. During the transmission, Somnoware appends other relevant patient information to the electronic order, so the DME company receives complete patient records. Also, if the DME order was originally placed by a non-physician, Somnoware offers the opportunity for the physician to electronically sign the order and append notes before it is sent to the DME company.

eSolutions gets new CEO

OVERLAND PARK, Kan. – eSolutions, a provider of revenue cycle management analytics and cloud-based workflow solutions, has named Gerry McCarthy CEO. McCarthy has more than 20 years of healthcare experience, most recently as president of TransUnion Healthcare, where he oversaw the rapid growth and strategic direction of the company. He replaces Gene Creach, who is retiring after 18 years at the company. Creach helped eSolutions grow to process more than 50 million claims a year for more than 30,000 providers. The company also provides nationwide Medicare connectivity across all nine Medicare administrative contractors. Its customers span hospitals, home health and hospice agencies, skilled nursing facilities, DME suppliers, physician practices and other provider types.

VMI donates van

PHOENIX – Vantage Mobility International has provided an accessible van to Ability360, a nonprofit organization that offers programs to empower people with disabilities. The van will be used to transport members and enable them to experience the most accessible sports and fitness center in the metro area, according to a press release. “Ability360 as an organization does so much for our community and reflects Vantage Mobility International’s values and mission to always remember the challenges our customers face and our desire to improve their independence and access to the greater community,” said Steve Morris, COO of VMI.

Quantum Rehab backs Team Gleason

EXETER, Pa. – Quantum Rehab has pledged to contribute $50,000 to the Team Gleason Foundation, a nonprofit that aims to provide leading edge technology, equipment and services to individuals with ALS. Quantum Rehab will also pay for seat-elevation technology, like its iLevel system, to be distributed by Team Gleason to individuals living with ALS. “Those living with ALS face daily challenges,” said John Storie, vice president, Quantum sales-Eastern America. “Access to life-sustaining mobility should not be one of them. It’s our privilege to work with Team Gleason to ensure that those living with ALS have the best mobility technology and the highest quality of life possible.” Team Gleason, founded by Steve Gleason, a former New Orleans Saints football player, after his diagnosis with ALS in 2011, is accepting applications from individuals living with ALS who are interested in a power seat elevator.

NRRTS taps Dickerson as next president

LUBBOCK, Texas – NRRTS has announced the results of its 2018 board elections, including Gerry Dickerson as president-elect. Dickerson works for National Seating & Mobility and has been a NRRTS registrant since 1994. Katie Roberts, who works for Cimarron Medical Services and has been a registrant since 2007, has been named vice president; Mike Osborn, who works for Alliance Rehab and Medical Equipment and has been a registrant since 2000, has been named treasurer for a second term; and Carey Britton, who works for NSM and has been a registrant since 2002, has been named secretary. Directors at large are Bob Harry of AABON Home Health Care Supply, a registrant since 2008; and Toby Bergantino of NuMotion, a registrant since 1993. Doug Crana of Consolidated Medical has been elected review chair, Region B; and Tom Simon of NuMotion has been appointed Review Chair, Region A.

Short takes: Medical Service Co., CareCentrix

Cleveland-based Medical Service Co. has been named a 2018 NorthCoast 99 winner. Winners represent the best workplaces in northeast Ohio. It’s the seventh time the provider has been recognized…Leslie Norwalk has been elected to CareCentrix’s board of directors. Norwalk has more than two decades worth of healthcare experience, including serving as Acting CMS Administrator during the Bush Administration.