In brief: Protests delay RAC rollout, Senior Respiratory expands

Sunday, November 9, 2008

BALTIMORE - CMS's Recovery Audit Contractor (RAC) program is temporarily on hold due to protests from two companies that did not receive awards, according to a Nov. 4 news report. Viant and PRG Schultz filed protests with the GAO on Oct. 6 disputing two of the four regional RAC contracts awarded to Diversified Collection Services, CGI Technologies and Solutions, Connolly Consulting Associates and HealthDataInsights. The contractors were to begin work in phases next year. The GAO has 100 days or until early February to issue its decision. Despite the delay, CMS will host a Special Open Door Forum on Nov. 13 from 2 to 3:30 p.m. EST to introduce providers to the new contractors and provide more information about the RAC program.

Senior Respiratory expands
TEXARKANA, Texas - Praxair Healthcare Services has contracted with Senior Respiratory Solutions to provide respiratory medications to 5,000 patients, David McDonald, president of Senior Respiratory, announced last week. "They decided to exit the unit dose market and chose us to provide those services, because we won't compete with them on oxygen or DME," he said. The deal positions the six-year-old Senior Respiratory as one of the largest privately held respiratory pharmacies in the country, McDonald said. Senior Respiratory began shipping to Praxair's customers Nov 7.

Medical Service Company pioneers deal
CLEVELAND - Medical Service Company has acquired Marietta-based Pioneer Home Medical, the company announced Nov. 3. The deal allows Medical Service Company to expand into the Ohio counties of Athens, Meigs, Monroe, Morgan, Nobel and Washington, and several northern West Virginia counties. This is the third acquisition made by Medical Service Company in the last year and a half.

Management company moves into home care
KNOXVILLE, Tenn. - Principle Pharmacy Group bought Omni Healthcare, a provider of home infusion, DME and respiratory therapy, the companies announced last week. The deal will allow Principle, a management and consulting company, to move directly into the home health industry. Omni has eight employees. It also operates the Memphis Specialty Clinic, which compounds medications for hospitals and home patients. The company plans to expand further into the DME and respiratory markets, along with extending pharmacy services to long-term care facilities. Terms of the deal were not disclosed.

Higby leaves Apria
LAKE FOREST, Calif. - Larry Higby recently stepped down from his post as Apria Healthcare Group's CEO, according to a news report. Higby, 63, has said he wants to retire, but for now, he will stay on as vice chairman and adviser. Higby joined Apria in 1997 as president and COO. He became CEO in 2002. His departure comes as Apria wraps up its sale to Blackstone Group, a $1.7 billion buyout.

Massachusetts man submitted false claims
BOSTON - The owner of Kings Enterprize in Quincy, Mass., allegedly defrauded Medicare of $1.4 million by submitting false claims and accepting reimbursement for DME that had not been prescribed by a doctor and in many cases, had not been provided to any beneficiary, according to a news report last week. In 2006 and 2007, Kingsley Tochukwu Eze allegedly used the names and identification numbers of doctors without their knowledge. A grand jury indicted Eze on 14 counts of healthcare fraud, two counts of aggravated identity theft and one charge of making a false statement.

CPAP criteria updated
WASHINGTON - CMS revised its national coverage determination (NCD) for CPAP. For coverage after the initial 12-week period, the patient must meet either of the following criteria, using the apnea-hypopnea index (AHI) or the respiratory disturbance index (RDI): AHI or RDI greater than or equal to 15 events per hour; or, AHI or RDI greater than or equal to 5 events, and less than or equal to 14 events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke.

CMS releases HCPCS updates
BALTIMORE -- CMS has posted changes to the HCPCS code set at The changes are effective Jan. 1 unless otherwise indicated.