In brief: Judge favors Lincare in whistleblower lawsuit, neb-med payments are up and down

Friday, July 17, 2015

MIAMI – A federal judge has ruled that two former Lincare employees failed to prove the provider violated Medicare telemarketing rules.

U.S. District Judge Kathleen Williams on July 10 issued a partial summary judgment that freed Lincare from most of the charges outlined in a whistleblower lawsuit accusing the provider of violating the False Claims Act.

The plaintiffs had argued that Lincare and its subsidiary, Diabetic Experts, violated Medicare rules by using improper sales leads to make unsolicited phone calls to beneficiaries, and by using “purportedly” false assignment of benefits given to Lincare.

The judge ruled that Diabetic Experts is a subsidiary of Lincare, not a separate entity; therefore, because the beneficiaries had received oxygen supplies from Lincare within the 15-month time period before the calls, those calls do not violate the False Claims Act.

The judge also ruled that all of the assignments of benefit in question “contain clear language providing for services to be rendered by ‘Lincare’ or ‘Supplier.’”

The plaintiffs have also charged, however, that other false claims might “lie” with Med4Home, Reliant Pharmacy Services, or other entities related to Lincare.

The judge ruled that both parties must file a joint status report by July 22 indicating what claims, if any, remain and how they want to proceed.

ASP: Up for brand name neb-meds

BALTIMORE – Third-quarter payments for respiratory drugs are up and down. Brand name drugs Brovana (J7605) and Perforomist (J7606) were up 16 cents and nearly 44 cents to $7.20 and $8.48 per dose, respectively. Payments for budesonide (J7626) were down nearly 38 cents to $5.20 per dose and payments for albuterol (J7613) were cut in half to 13.5 cents per dose. Ipratropium (J7644) stayed relatively flat at just under 11 cents per dose.

Hospital group taps former CMS administrator as new leader

WASHINGTON – The board of directors of America’s Health Insurance Plans has elected Marilyn Tavenner, the former administrator of CMS, as its president and CEO. The appointment is raising eyebrows on Capitol Hill, with Tavenner now representing and lobbying on behalf of large health insurers that are regulated by CMS. These insurers are also looking to Medicare Advantage as a key growth area for their businesses. Tavenner replaces Karen Ignagni, who served as AHIP’s top lobbyist for 22 years. Ignani is headed to New York-based insurer EmblemHealth.

ActivStyle secures financing

MINNEAPOLIS – ActivStyle has obtained a credit facility from Garrison Investment Group, it announced July 14. The provider of incontinence products will use the proceeds to refinance debt and provide capital for growth, according to a press release. Terms of the deal, which consists of a term loan and revolving credit facility, were not disclosed. ActivStyle is a portfolio company of The Riverside Group. In addition to incontinence products, the provider offers urological, enteral, ostomy and wound care products.

Lewarski joins Drive-DeVilbiss team

PORT WASHINGTON, N.Y. – Joseph Lewarski has joined DeVilbiss Healthcare as vice president of global respiratory and sleep categories, Drive Medical announced July 14. DeVilbiss is a subsidiary of Drive. In his role, Lewarski will work with the company’s global sales and product management teams to grow the categories. Lewarski has more than 30 years of experience in health care, including seven years with Invacare. “This is an exciting time to be joining the Drive-DeVilbiss team,” said Lewarski. “There is tremendous growth potential for the company in the respiratory and sleep categories.” Drive acquired DeVilbiss earlier this month.

CMS uses data to thwart $820M in fraud

WASHINGTON – CMS’s Fraud Prevention System has identified and prevented $820 million in inappropriate payments in three years of use, the agency announced last week. In 2014 alone, the system identified or prevented $454 million in inappropriate payments, a 10 to 1 return on investment, it says. “We are proving that in a modern health care system you can both fight fraud and avoid creating hassles for the vast majority of physicians who simply want to get paid for services rendered,” said Andy Slavitt, acting administrator of CMS. “The key is data.” The system uses predictive analytics to identify troublesome billing patterns and outlier claims for action similar to systems used by credit card companies. Going forward, CMS plans to expand the system and its algorithms to identify lower levels of non-compliant healthcare providers who would be better served by education or data transparency interventions.

OIG certifies CMS’s fraud savings

WASHINGTON – The Office of Inspector General has certified $133.2 million of actual and projected savings from CMS’s Fraud Prevention System, a return of investment of $2.84 for every dollar spent on the system. The OIG also certified $454 million in unadjusted savings identified by the system. The Small Business Jobs Act of 2010 requires the OIG to certify the actual and projected savings related to the system for each of its first three years. This most recent report fulfills the OIG’s responsibilities for the third year. To help identify and better report savings from the system, the OIG recommends that CMS provide its contractors with improved written instructions on how to attribute savings accurately and better document the contribution of the system toward achieving administrative actions. CMS agreed and has outlined steps for making these improvements. Earlier this month, the agency announced that the system identified and prevented $820 million in inappropriate payments in three years of use.

Study: Vent therapy cuts readmission rates for COPD patients

ANDOVER, Mass. – Readmission rates for COPD patients who were hospitalized two or more times within a year and who were transitioned to a patient management program that included treatment with non-invasive positive pressure ventilation were reduced 97% during the subsequent 12 months, according to new research published in the Journal of Clinical Sleep Medicine. The proportion of COPD patients included in the study who were readmitted on two or more occasions decreased from 100% (397 of 397) in the year prior to initiation of intervention to 2.2% (9 of 397) in the following year. The study, authored by Steven Coughlin, PhD, Wei Liang, PhD, and Sairam Parthasarathy, MD, examined 397 patients who had all been hospitalized at least twice in a single year with an acute COPD exacerbation. Each patient was prescribed a Trilogy ventilator manufactured by Philips Respironics for home use. Continued in home care consisted of medication management, oxygen therapy, patient education and ongoing respiratory therapist care in the home. “This study holds promise in how a multi-faceted intervention could assist health systems in significantly improving the care of the patients with advanced stage COPD in their home,” said Parthasarathy, professor of medicine and director of the Center for Sleep Disorders at Banner University Medical Center in Tucson.

NCPA announces student finalists

ALEXANDRIA, Va. – The National Community Pharmacists Association has named the finalists for the 2015 Good Neighbor Pharmacy NCPA Pruitt-Schutte Student Business Plan Competition. The three teams are from the South Carolina College of Pharmacy, the University of Arkansas for Medical Sciences College of Pharmacy, and the University of Minnesota College of Pharmacy. They will present their business plans in a live competition Oct. 10 at NCPA’s annual convention. The goal of the competition is to motivate pharmacy students to create a business model for buying an existing independent community pharmacy or opening a new pharmacy, according to a press release.

Short takes: Point-of-Rental Software, Univita

Point-of-Rental Software, a Grand Prairie, Texas-based company offering rental and inventory management solutions to thousands of companies worldwide, including HME companies, was one of nine finalists competing for the Cloud Innovator of the Year title at the 2015 Cloud Innovation World Cup Awards on July 8. Held at Google headquarters in New York, the awards identified advancements in cloud computing, with the goal of fostering cutting-edge solutions. Point-of-Rental Cloud was chosen as a finalist out of 312 software products from 59 countries…Univita Health has joined the Florida Association of Health Plans. The provider of post-acute and home healthcare solutions has also signed on as a gold sponsor of the FAHP’s upcoming annual conference in Orlando. The FAHP is the state’s trade association representing Florida’s health plans…The U.S. Small Business Administration will sponsor two Regulatory Enforcement Fairness Roundtable discussions July 21 in Bozeman, Mont., and July 23 in Great Falls, Mont. The VGM Group encourages providers in the area to attend to voice their concerns about CMS’s audit and appeals process, and the agency’s national rollout of competitive bidding pricing…Hollister has consolidated its product line to focus on its VaPro Plus intermittent catheter.