In brief: Overpayments persist for diabetes supplies, MedCare & Medical Service on growth streak

Wednesday, November 25, 2015

INDIANAPOLIS – The Office of Inspector General is not satisfied with National Government Services’ progress in preventing overpayments for diabetic test strips.

The OIG found that NGS, the DME MAC for Jurisdiction B, made payments to suppliers for dispensed strips when the beneficiaries had not nearly exhausted previously dispensed strips by different suppliers, resulting in overpayments of about $3.2 million in 2013.

“NGS stated (in response to a previous review in 2007) that it was in the process of developing a system edit that would address the problem of overlapping dates of service on claims for individual beneficiaries,” the OIG stated in a report published last week. “We conducted this follow-up review to determine whether this system edit had been implemented and was effective in preventing overpayments.”

The OIG based its findings on a sample of 100 claims. It found 17 were allowable, 13 were non-errors because the suppliers were no longer in business and the supporting documentation could not be obtained, and 70 may have not been allowable because the suppliers dispensed strips before the beneficiaries’ existing supplies were nearly exhausted. For more than half of the 70 claims, the suppliers dispensed strips when there were more than 60 days remaining in the beneficiaries’ existing supplies.

On the basis of the sample, the OIG estimates about $3.2 million, or 74%, of the $4.4 million that NGS paid to suppliers may have been unallowable for Medicare reimbursement.

The OIG recommends that the NSG implement a system edit to identify claims submitted by multiple suppliers with overlapping service dates for strips dispensed to the same beneficiary. It argues that the contractor’s current system was designed only to identify claims with a quantity of strips that exceeds the utilization guidelines.

MedCare adds two health systems in one month

GREENSBURG, Pa. – MedCare Equipment Company has signed on Indiana Regional Medical Center as its latest health system partner, in a move that adds about 1,000 patients and $2 million in revenues to its books. “This is an excellent example of how strong community health systems can collaborate,” said Stephen Wolfe, president and CEO of Indiana Regional Medical Center. “We can improve care to patients and reduce costs to employers while remaining independent and focused on our local community.” MedCare, which provides respiratory and HME to patients in western Pennsylvania and neighboring states, already has partnerships with a number of health systems, including UPMC Altoona. It acquired Home Health Resource from UPMC Altoona in early November. With the addition of Indiana Regional Medical Center, MedCare will serve 25,000 patients annually, with a revenue base of $72 million. It employs 320 people in 14 locations.

Medical Service Company announces location, promotion

CLEVELAND, Ohio – Medical Service Company has opened its second new location this month, this time in Rochester, N.Y. The location will offer oxygen, respiratory and sleep equipment and services. Earlier this month, the provider opened a location in Crestview Hills, Ky. Medical Service Company has also promoted Judy Bunn to director of revenue cycle and compliance. Bunn also serves on several industry boards and councils, including as chairwoman of AAHomecare’s regulatory council.

Invacare adds diabetes expert to board

ELYRIA, Ohio – Invacare has appointed Marc Gibeley to its board of directors. Gibeley is the head of diabetes care, North America, for Roche Holding AG and is responsible for all aspects of the company’s blood glucose monitoring and insulin pump business, including sales, marketing, finance, customer support and product launches. “He has a keen understanding of the population that we serve, the ongoing healthcare reform changes that impact our business, and the rise of consumerism in the medical device space,” Invacare stated in a press release. Gibeley is the third new independent director to join Invacare’s board over the past year and a half. He joins the board after a search by a nationally recognized firm.

ResMed Halifax gets rebate deal

HALIFAX, Nova Scotia – ResMed Halifax will earn a rebate of up to $787,500 over five years from the province of Halifax if it creates 40 new jobs, according to Nova Scotia Business. ResMed acquired the Halifax-based Umbian in 2012 and renamed it ResMed Halifax. Umbian is the developer of U-Sleep, a web-based software solution to track CPAP usage by long haul truckers.

Reid Health opens retail location

GREENVILLE, Ohio – Reid Health is opening a 1,500-square-foot retail location for home health supplies here, according to the Dayton (Ohio) Business Journal. Reid Health Medical Equipment & Uniforms opens its doors Nov. 30, offering home safety aids, oxygen units, hospital equipment, and diabetes and mastectomy supplies. Three employees will man the location, with support from the company’s Richmond, Ind., headquarters, according to the newspaper. Reid Health includes a 217-bed hospital and numerous satellite locations in Eastern Indiana and Western Ohio, serving about 280,000 people.