In brief: CMS publishes RAC results, Merits clears FDA hurdle

Friday, February 8, 2013

WASHINGTON – Medicare’s Recovery Audit Contractors (RACs) identified $939.3 million in improper payments in fiscal year 2011, according to a report issued by Health and Human Services Secretary Kathleen Sebelius on Feb. 5. Included in that number: 295,990 HME claims representing $34 million in overpayments, and 166 HME claims representing $12,400 in underpayments. The report also delves into how many claims were appealed and overturned in FY 2011. “Medicare providers appealed 60,717 claims, which constitute 6.7 percent of all claims with overpayment determinations,” it states. “Of those claims appealed, 26,469 claims were overturned (43.6 percent).” Though Sebelius calls the program “successful,” she acknowledges the need for improvements, including working more closely with Medicare Administrative Contractors (MACs) to improve understanding of coverage policies. “CMS is sensitive to the concerns of the provider and supplier communities and continues to work with these communities to reduce the burden of the review process,” the report states.

Merits clears FDA hurdle

CAPE CORAL, Fla. – Merits Health says the U.S. Food and Drug Administration (FDA) has cleared its manufacturing facility in Taiwan. In a letter dated Jan. 30, the FDA states: “The Food and Drug Administration has completed an evaluation of your firm’s corrective actions in response to our warning letter. Based on our evaluation, it appears that you have addressed the violations contained in this warning letter.” In a warning letter dated Nov. 11, 2011, the FDA notified Merits Health of eight violations concerning manufacturing and processes at the facility. The FDA states that it will continue to monitor Merits Health’s compliance. “This letter will not preclude any future regulatory action should violations be observed during a subsequent inspection or through other means,” the FDA states. Merits Health says its lifts, wheelchairs and scooters are now in the process of being removed from the FDA’s “import alert” watch list.

Medtrade Spring special pricing ends today

LAS VEGAS – The early bird rates for Medtrade Spring end today, Feb. 11. The rates are $99 for the conference educational sessions and $25 for the Expo Pass. This year’s show takes place March 19-21 at the Mandalay Bay. To register:

New Mexico sleep center now also a provider

SANTA FE, N.M. – The Southwestern Sleep Center, previously just a sleep testing facility, is now also a provider of CPAP devices and supplies, according to a press release. The company will continue to provide sleep testing services for sleep apnea, but will now also offer patients, after an evaluation and upon the recommendation of a doctor, the ability to get their CPAP devices and related accessories in the same place they got tested. The Southwestern Sleep Center said its new status will make the sleep apnea diagnosis and treatment process more convenient for patients.

Study: 85% of military personnel have sleep disorder

TACOMA, Wash. – A study has found that 85% of U.S. military participants had a clinically relevant sleep disorder, according to an article from a military news service. Of those, 51% had obstructive sleep apnea. The study, published in the journal Sleep and conducted by researchers at Madigan Army Medical Center, found that participants slept a mean of only 5.74 hours per night, with 41.8% reporting sleeping five hours or fewer per night. The study analyzed 725 diagnostic polysomnograms, which are used to diagnose sleep problems. Participants were active duty military personnel from the U.S. Army, Air Force and Navy; 93.2% were men; 85% were combat veterans. "While sleep deprivation is part of the military culture, the high prevalence of short sleep duration in military personnel with sleep disorders was surprising," stated Dr. Vincent Mysliwiec, the study’s lead author, in a statement. "The potential risk of increased accidents as well as long-term clinical consequences of both short sleep duration and a sleep disorder in our population is unknown."

Neighborhood Diabetes passes test

WOBURN, Mass. – For calendar year 2010, Neighborhood Diabetes submitted claims for testing supplies without the KL modifier in accordance with Medicare billing requirements, according to a review conducted by the Office of Inspector General (OIG). Of 100 sampled line items, 99 were properly submitted without the KL modifier because Neighborhood used company-owned vehicles for delivery. Medicare billing guidelines require suppliers to submit claims with the KL modifier for mail-order diabetes testing supplies, which are reimbursed at a lower amount than supplies provided at local storefronts. The remaining sampled line item should have been submitted with the KL modifier because Neighborhood had delivered the supplies by mail. Neighborhood discovered this error during the OIG’s audit and resubmitted the claim with the KL modifier. Consequently, the OIG’s report has no recommendations.

Doctor, HME provider guilty of wheelchair scam

SAN DIEGO – A medical doctor and the owner of an HME company have both pled guilty to participating in a scheme that defrauded Medicare of more than $1 million, according to a press release from the United States Attorney’s Office for the Southern District of California. According to court papers and admissions by the defendants, Dr. Irving Schwartz and Jose Melendez, owner of Oceanside Medical Supply in Long Beach, Calif., conspired to obtain reimbursement from Medicare for power wheelchairs that patients did not need and, in some cases, did not want. Dr. Schwartz admitted in court that he wrote at least 186 fraudulent prescriptions for power wheelchairs in exchange for more than $55,000 in bribes and kickbacks, while Melendez admitted to purchasing these 186 fraudulent prescriptions and using them to submit more than $830,000 in false claims to Medicare. As part of their plea agreements, the defendants are obligated to pay restitution to Medicare.

Study: Diabetes Health Plan offers reduced costs

MINNEAPOLIS, Minn. – A two-year study from UnitedHealthcare found that Diabetes Health Plan (DHP) participants saw reduced costs compared to that of a control group, according to a press release. The study followed 620 people with diabetes for two years, examined their compliance with six key diabetes testing requirements, and found that healthcare costs for DHP patients rose at a 4% slower pace than that of the control group. In addition, the study found that disease management was more effective because of certain incentives built into the plan, including offering some diabetes supplies and diabetes-related prescription drugs at no charge, which increased adherence to treatment guidelines, the press release stated. On average, DHP participants achieved compliance with 75% of the key requirements versus 61% for people not enrolled. The compliance rate of plan participants increased 6% over the two years.

Vendor short takes

ResMed CEO and Executive Chairman Peter Farrell sold 400,000 shares at an average price of $46.98 on Jan. 30. Farrell made the sale the same day CMS announced a reimbursement cut of, on average, 45% as part of Round 2 of competitive bidding, which drove ResMed’s stock price to drop more than 6%...Harmar has added an international sales office based in the Netherlands. Richard Koopmans will serve as managing director of the office…ACHC is offering new payment options. ACHC will continue to require a standard $1,500 deposit with the application, but providers now have the option to pay the remaining balance using one of three payment options: in full, within 30 days of signing the contract; in monthly installments within 18 months; or in six payments every three months until the balance is cleared…Basic American Medical Products has earned an “Elite Supplier” distinction for the 9th Annual LTC & Senior Living LINK Conference. This award is given to the suppliers that participated in LINK 2012 and ranked in the top 25% of suppliers based on provider scores for their ability to be consultative, innovative and address specific needs.

Provider short takes

National Seating and Mobility and Groton’s Fort Hill Pharmacy helped to donate 12 new wheelchairs to Mystic Aquarium. NSM and Groton’s provided the wheelchairs, worth more than $25,000, at more than 50% off retail to UnitedHealthcare, which donated them to the aquarium…The Scooter Store, along with the host of a PBS fitness show, has put together a booklet with a series of exercises for people living with limited mobility. To produce the booklet, TSS teamed up with Mary Ann Wilson, RN, founder, executive director and host of the PBS TV show “Sit and Be Fit.”


It's so strange to me that CMS is boasting about how much money they are saving with competitive bidding. What they don't tell you is how the care of the person is about that of a third world country now.

They don't care how many business's they put out of business. A business that truly tries to help the person in need. They don't brag about how many people are going to die because the diabetic test strips won't read right and they won't find out until it's too late.

I agree with getting better pricing but how about we get people in on panels to discuss cost. How about we have people that know what they are doing over "big wigs" that are just there for the money.

In the very near future a person in need won't be able to find anyone that takes Medicare because the company cannot afford to. Then the person in need decides do I get the cane I need to help me walk or do I eat this week.

It won't dawn on any of these people in power until it happens to their mom or dad.



Rose Johnson