In brief: Court protects access to incontinence supplies, Quantum Rehab buys Stealth Products
PHOENIX – The 9th U.S. Circuit Court of Appeals has voided a cost-saving bid by Arizona’s Medicaid program to deny incontinence briefs to adults who need them. The Arizona Health Care Cost Containment System (AHCCCS) contended that briefs are only medically necessary when prescribed to treat skin breakdown or infections due to incontinence and that doctors were preemptively prescribing them before any medical problems arose, the Arizona Daily Star reported. The ruling by the three-judge panel leaned on AHCCCS’s own rules, which state that products are medically necessary when a doctor prescribes them “to prevent disease, disability, or other adverse health conditions or their progression,” the newspaper reported. The judges also pointed out that CMS approved AHCCCS’s definition of medical necessity, but not an amendment carving out incontinence briefs, the Daily Star reported.
Quantum Rehab buys Stealth Products
EXETER, Pa. – Quantum Rehab, a Pride Mobility Products company, has acquired Stealth Products, a Burnet, Texas-based manufacturer of complex rehab technology components and accessories. Per the deal, Stealth Products’ management team, including President Lorenzo Romero, and its employees will continue to operate independently. “By aligning the two companies within the larger complex rehab technology industry, we’re able to expedite developing and delivering the needed technologies to help those with disabilities lead the most independent, enriched lives,” stated Scott Meuser, chairman and CEO of Pride Mobility, in a press release. Stealth Products manufactures specialty drive controls, head and body positioning components, specialty mounting hardware, and pediatric mobility solutions. This is only the most recent move made by Quantum Rehab and Pride Mobility to strengthen their position in the market. The companies already have a partnership with Comfort Company to ramp up sales of Quantum and Pride manual wheelchairs, and they have a strategic alliance with Active Controls to offer products like the JoyBar on their power wheelchairs.
Gov’t cracks down on ‘brazen’ fraud
WASHINGTON – The Medicare Fraud Strike Force has charged 90 individuals with $260 million in false billings, according to a May 13 release from the Department of Justice. Those charged include physicians, nurses and other medical professionals. “The crimes charged represent the face of health care fraud today—doctors billing for services that were never rendered, supply companies providing motorized wheelchairs that were never needed, recruiters paying kickbacks to get Medicare billing numbers of patients,” said Acting Assistant Attorney General David O’Neil. “The fraud was rampant, it was brazen, and it permeated every part of the Medicare system.” The defendants are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes and money laundering. The charges stem from alleged fraud schemes involving various medical treatments and services, including home health care, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment and pharmacy. More than half of those charged were part of an alleged fraud scheme involving false billing for home health care and mental health services and pharmacy fraud in Miami. Since 2007, the Strike Force has charged nearly 1,900 individuals with approximately $6 billion in fraud, according to the release.
VGM to roll out Audit Task Force
WATERLOO, Iowa – The VGM Group’s U.S. Rehab will roll out an Audit Task Force at its Heartland Conference, June 9 through June 12, said U.S. Rehab President Greg Packer. Task force members Peggy Walker, Ronda Buhrmester and Dan Fedor will offer billing and reimbursement advice; review claims and audits providers feel were incorrectly denied; answer questions on National Supplier Clearinghouse issues; and offer ongoing educational opportunities for members of VGM and U.S. Rehab.
Liberator Medical holds on
STUART, Fla. – Liberator Medical’s reported a sales of $17.6 million for its second fiscal quarter ended March 31, 2014, a 5.3% increase compared to the same period in 2013, the company announced May 15. Net income for the quarter was $1.6 million. Cash on-hand was nearly $9.6 million compared with $12.4 million for the quarter ended Sept. 30, 2013. "In the second quarter we encountered our normal seasonal sales weakness associated with the renewal of calendar year deductibles, continued delayed payments due to Medicare's industry wide auditing of medical supply claims and a significant increase in income tax payments,” said Mark Libratore, president/CEO. Liberator began trading on the New York Stock Exchange in November.
Sleep apnea market to grow 7.8%
YARMOUTH, Maine – The global sleep apnea market for diagnostic and therapeutic equipment is expected to increase 7.8% from $3.8 billion in 2012 to $6.43 billion by 2019, according to a report released May 12 by Transparency Market Research. While polysomnography devices comprised the largest share of the market in 2012 (28.35%), technological advances in devices like actigraphy systems and pulse oximeters are expected to drive future growth. North America accounted for the largest market share in 2012 due to high levels of sleep apnea awareness, the rising prevalence of obesity and the presence of well-equipped sleep labs.
VMI offers financing through Bank of America
PHOENIX – Vantage Mobility International (VMI) customers may now apply directly for financing from Bank of America using a link from VMI’s website under a new agreement announced May 15. Decisions are usually made within 15 minutes, according to the release, and approved customers receive phone calls within an hour. “Our goal was to help VMI streamline the credit application process for those who need wheelchair accessible transportation,” said John Hyatt, president of Bank of America Dealer Financial Services. “We share VMI’s commitment to make it easier for these customers to pursue financing options for vehicles that can help transform their lives.” Loans can be used to purchase new or used wheelchair accessible vans at any VMI dealership in the U.S.
Error rate for glucose test strips tops out
INDIANAPOLIS - A prepayment review of glucose test strips resulted in a claim error rate of 99.2%, according to National Government Services. The Jurisdiction B DME MAC reviewed 8,758 claims filed between Jan. 1 and March 31. The top four reasons for denial: lack of medical necessity, documentation not returned within the requested time frame, billing more than the standard allowed quantity, and incorrect modifier submitted. Claims denied due to lack of medically necessity were missing progress notes, proof that the testing frequency was medically necessary or the quantity of supplies remaining for the refill requests; were already billed or paid to the same or a different supplier or same or similar dates of service; were billed with the KS modifier instead of the KX modifier to indicate the beneficiary used insulin; included a written order without the quantity to be dispensed; or included a proof of delivery record that lacked sufficiently detailed descriptions to identify the items delivered.
Allegro Medical survey links incontinence, depression
BOLINGBROOK, Ill. – People purchasing incontinence products look at comfort, capacity and cost, a new survey by Allegro Medical has found. The survey found 95% use incontinence products themselves or for a spouse or parent; 90% say their condition keeps them from participating in favorite activities; and more than 85% say they suffer from depression. “A growing number of people who are experiencing incontinence will usually wear some sort of protective layer so that accidents will be discreet and easy to clean,” said Craig Hood, executive vice president. “With the right products, a person can usually live an active lifestyle.” The survey also found that the leading causes of incontinence are prostate issues and physical trauma for men, and obesity and diabetes for women.
Review results in 87.7% error rate for power wheelchairs
INDIANAPOLIS – The claim error rate for Group 2 power wheelchairs without power seating options was 87.7% between Jan. 1 and March 31, according to National Government Services (NGS), the Jurisdiction B DME MAC. Of 389 claims filed, 48 were paid in full, with the rest fully or partially denied. The most common reasons for denials: face-to-face documentation failed to prove a manual wheelchair wouldn’t meet the beneficiary’s needs in the home, the beneficiary had a significant mobility limitation requiring a power wheelchair, or why a power-operated vehicle wouldn’t meet the beneficiary’s needs in the home; and coverage criteria did not show the beneficiary lacks upper extremity strength to propel a manual wheelchair in the home or that a cane or walker were unsuitable alternatives. NGS reminded providers they are required to respond to requests for additional documentation.
National Sleep Therapy makes buy
NORWOOD, Mass., & WALLINGFORD, Conn. – National Sleep Therapy (NST) has acquired Gaylord Sleep Medicine Equipment. Gaylord, a division of Gaylord Hospital, operates four sleep labs. “Gaylord Sleep and National Sleep Therapy have been working collaboratively during the past year to develop a sleep equipment program that is one of the best in the U.S.,” said Joseph Zangrilli, vice president of operations for NST. “We believe the new combination will result in a great patient experience and result in better outcomes.” NST, which accepted several contracts for CPAP in Round 2 of competitive bidding, acquired Rest Ensured Medical in 2012.
3B/BMC scores patent victory
LAKE WALES, Fla. – 3B/BMC Medical has successfully invalidated a ResMed patent on a “cushion for patient interface” in China, it announced today. BMC in October initiated proceedings before the Chinese Patent Re-examination Board against five ResMed patents. BMC is also in the process of preparing IPR (Inter Partes Review) applications seeking to invalidate several ResMed patents in the U.S. Patent and Trademark Office. In April, the two companies concluded a trial before the International Trade Commission that was the result of a complaint filed by ResMed alleging infringement on several patents. A final decision is expected in December.
Truefit CPAP supplies hit walmart.com
BOSTON – PBM Capital has announced that its Truefit CPAP supplies and accessories are now available nationwide through Walmart.com. The Truefit line of products includes filters for more than 60 popular CPAP machines; replacement hoses and tubing; and a full line of accessories, such as chin straps, headgear, cleaning solutions, gel pads and hose wraps, according to a press release. “Until now, CPAP supplies have been sold exclusively through medical supply stores making them expensive and inconvenient for consumers to access,” the release states. “Truefit is the first full line of CPAP supplies sold through Walmart.” The release echoes a recent brochure touting the availability of the Truefit line of supplies and accessories at Walmart.
Bills get boost from complex rehab conference
WASHINGTON – Lobbying visits conducted during the recent CRT Leadership & Advocacy Conference are paying off. NCART reported this week that 13 new lawmakers have signed on to a bill in the House of Representatives to create a separate benefit for complex rehab. One additional lawmaker has signed on to a similar bill in the Senate. H.R. 942 and S. 948 now have 122 and 13 co-sponsors, respectively.
People in the news
Todd Tyson received the 2014 Legislative Advocate Award at the AAHomecare Washington Legislative Conference earlier this month. AAHomecare recognized Tyson for his contributions of time, effort and leadership to advance the association’s government affairs efforts…Michael Merriman has been elected to Invacare’s board of directors. He is currently an operating advisor for Resilience Capital Partners, a private equity firm focused on principal investing in lower middle market underperforming and turnaround situations…Gary Cox, CEO of PMDRX, is running for a state Senate seat in Arizona. Cox, who has also owned two DME companies, seeks to represent District 30. Part of his platform: introduce legislation to fix loopholes in the state Medicaid program that allow “Medicaid contracted payers to reap millions of dollars in profits at the expense of patient providers,” he says…Ali Bauerlein, Brenton Taylor and Byron Myers, the trio who founded Inogen in 2001, have received the Venky Narayanamurti Entrepreneurial Leadership Award, also known as “The Venky.” The award, given by UC Santa Barbara’s College of Engineering, honors leadership and success in the high technology entrepreneurial community in the region…Van Miller, founder of The VGM Group, is one of three Iowa-based finalists for the Ernst & Young Entrepreneur of the Year award for the Upper Midwest. He travelled to Minneapolis last week for interviews with a panel of judges. The winner will be announced June 11.