In brief: US joins lawsuit against Arriva, SMRC targets PAP supplies

 - 
Friday, February 22, 2019

NASHVILLE, Tenn. – The U.S. Justice Department has joined in a lawsuit that alleges Arriva Medical offered Medicare beneficiaries “free upgrades” of glucometers.

The lawsuit, filed under the False Claims Act, also alleges that Arriva and its parent company, Alere, submitted false claims for medically unnecessary glucometers, and paid kickbacks to beneficiaries in the form of free glucometers and co-pay waivers.

Additionally, it alleges Arriva made no meaningful effort to collect co-pays from beneficiaries, a violation of the Anti-Kickback Statute.

“When medical equipment companies scheme to enrich themselves by unlawfully increasing the sales volume of durable medical equipment, they place our federal health care programs in jeopardy,” said Donald Cochran, U.S. Attorney for the Middle District of Tennessee. “The restrictions imposed by federal statutes exist to prevent improper practices, including providing unnecessary medical equipment and billing Medicare for it. We will continue to enforce the laws that protect the integrity of federal health care programs.”

The Coral Springs, Fla.-based Arriva, a mail-order diabetes testing supply company, ceased operations in December 2017 after losing an appeal seeking to reinstate its Medicare billing privileges. CMS revoked those privileges in 2016, alleging the provider submitted 211 claims for deceased patients between April 15, 2016, and April 25, 2016.

Prior to that, Arriva had been the top provider of mail-order diabetes supplies, receiving nearly $120 million in Medicare payments in 2015.

Arriva was acquired by Alere, a Waltham, Mass.-based medical device manufacturer, in 2011; both companies were acquired by Abbott Laboratories in 2017.

Health share of GDP to hit 19.4% by 2027, report says

WASHINGTON – National health expenditure growth is expected to average 5.5% annually from 2018-2027, reaching nearly $6 trillion by 2027, according to a report published by the Office of the Actuary at CMS.

Growth in national health spending is projected to be faster than projected growth in gross domestic product by 0.8% over the same period.

As a result, health share of GDP is projected to increase from 17.9% in 2017 to 19.4% by 2027, the report says.

National health spending over the next decade is expected to be driven by:

·      Key economic factors, such as growth in income and employment;

·      demographic factors, such as the baby boom generation continuing to age from private insurance into Medicare; and

·      increases in prices for medical goods and services, which are projected to grow 2.5% over 2018-27 compared to 1.1% over 2014-17.

Similar to last year’s findings, the report found that by 2027, federal, state and local governments are projected to finance 47% of national health spending, an increase of 2% from 45% in 2017.

As a result of comparatively higher projected enrollment growth in Medicare, average annual spending growth in Medicare (7.4%) is expected to exceed that of Medicaid (5.5%) and private health insurance (4.8%).

Underlying the strong average annual Medicare spending growth are: projected sustained strong enrollment growth as the baby boomers continue to age into the program and growth in the use and intensity of covered services that is consistent with the rates observed during Medicare’s long-term history, the report says.

SMRC adds PAP supplies to to-do list

WASHINGTON – Noridian Healthcare Solutions, the Supplemental Medical Review Contractor, has added PAP supplies to its review list. The audit is a post-payment review of claims for dates of service from Jan. 1, 2017, through Dec. 31, 2017, according to a blog from the van Halem Group. The Office of Inspector General previously found that Medicare allowed replacement of PAP supplies more frequently than was reasonable and necessary; and that DME suppliers often did not have the required documentation. Documentation requirements that will be included in each AFR include: valid order for the PAP supplies and accessories billed; medical record documentation to support continued need; timely refill request documentation; proof of delivery; legible handwritten or valid electronic signature; and advance beneficiary notice of non-coverage, if applicable.

AASM outlines CPAP therapy recommendations

YARMOUTH, Maine – Strong recommendations from the American Academy of Sleep Medicine’s new clinical practice guideline for CPAP therapy include that educational interventions be given with initiation of PAP therapy in adults with OSA. Other strong recommendations: that PAP therapy be initiated using either APAP at home or in-laboratory PAP titration in adults with OSA and no significant comorbidities; that clinicians use either CPAP or APAP for ongoing treatment of OSA in adults; and that clinicians use PAP, compared to no therapy to treat OSA in adults with excessive sleepiness. The guideline also has conditional recommendations, including that clinicians use CPAP or APAP over BPAP in the routine treatment of OSA in adults; that behavioral and/or troubleshooting interventions be given during the initial period of PAP therapy in adults with OSA; and that clinicians use telemonitoring-guided interventions during the initial period of PAP therapy in adults with OSA. To develop the guideline, the AASM commissioned a task force of experts in sleep medicine. They conducted a systematic review to identify studies and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process to assess the evidence.

Diabetes research: One Drop, Abbott

One Drop has announced the results of a study demonstrating a -0.93 absolute A1c improvement among people with Type 2 diabetes who use its digital therapeutic solution and Afrezza, an inhaled insulin. What’s more, A1c improved with the One Drop solution—One Drop Mobile app, One Drop Chrome glucose meter and testing supplies and One Drop Experts coaching—regardless of what type of insulin was used, according to outcomes presented at the 2019 Advanced Technologies & Treatments for Diabetes conference in Berlin. Previous research had already showed Afrezza improves the A1c of people with Type 2 diabetes…Abbott has announced data from three real-world evidence studies, which for the first time included data from the United States, highlighting key benefits for people who use the FreeStyle Libre flash glucose monitoring system. They include reduction in prolonged hypoglycemia, better glucose control, decreased time in hyperglycemia and hypoglycemia, and increased time in optimal glucose range with frequent scanning, according to data presented at the ATTD conference. The FreeStyle Libre reads glucose levels through a sensor that can be worn on the back of the upper arm, eliminating the need for fingersticks.

MCO bill clears Kentucky House

FRANKFORT, Ky. – A bill that would hold managed care organizations more accountable passed the Kentucky House of Representatives on Thursday 100-0, VGM reports. The bill, H.B. 224, would ensure that DME providers are paid at the rate set by the Kentucky Medicaid program and would ensure that when they receive prior authorizations their claims can’t be denied for “lack of medical necessity.” Stakeholders, including members of KMESA, had been lobbying hard to move the bill in the past couple of weeks. It now moves to the Senate. The bill would also require that specialty items, such as parts to customize wheelchairs, are reimbursed at the manufacturer’s suggested retail price minus 15% or an invoice cost plus 20% when there is no MSRP; require that, should a patient transfer from one MCO to another, services that are currently being provided under a PA will be honored by the new MCO; and require MCOs to cover, at a minimum, the same quantities of supplies covered under the Medicaid fee schedule.

Standing wheelchair survey deadline Feb. 28

ARLINGTON, Va. – RESNA has developed a survey to build support for the medical necessity of standing wheelchairs. There is an ongoing dispute among insurers about the medical benefit of standing wheelchairs and, therefore, an ongoing dispute about funding for these items, according to a bulletin from RESNA. The survey will be used to gather baseline data and general information to help determine whether there is a need for future surveys. Survey responses are due Feb. 28.

ResMed, F&P put patent disputes behind them

SAN DIEGO and AUCKLAND, N.Z. – ResMed and Fisher & Paykel Healthcare have agreed to settle all outstanding patent infringement disputes between the two companies. The settlement includes no payment or admission of liability by either side, according to a press release. Under the agreement, all ongoing proceedings against named products—including ResMed’s AirSense flow generators; AirFit P10, Swift LT and Swift FX masks; and F&P’s Simplus, Eson and Eson 2 masks—will be dismissed. “This agreement supports the best interests of ResMed and all of our stakeholders, including patients, providers, physicians, and shareholders,” said ResMed CEO Mick Farrell. F&P also said it was pleased with the outcome. “We have an ongoing commitment to improve patient care and outcomes through inspired and world-leading healthcare solutions and this resolution supports that commitment,” said CEO Lewis Gradon. The two companies have been embroiled in disputes for several years.

Abbott, Novo Nordisk seek to eliminate ‘hassle’

ABBOTT PARK, Ill. – Abbott and Novo Nordisk have partnered to integrate insulin dose data from Novo Nordisk’s connected insulin pens with digital health tools compatible with Abbot’s FreeStyle Libre continuous glucose monitoring system. The integration will allow healthcare professionals, caregivers and patients to view glucose and insulin data together to help them make better informed treatment decisions, according to a press release. "It is our aim at Abbott to continuously provide life-changing technology to people living with diabetes," said Jared Watkin, senior vice president, Diabetes Care, Abbott. “By enabling insulin dosing data from Novo Nordisk′s connected pens to be shared with our digital health tools, we′ll be able to help further eliminate those daily hassles for people, so they have more time to live a fuller, healthier life."

PHS to promote online learning

ST. PAUL, Minn. – Pediatric Home Service will present a case study on creating online education at the National Home Infusion Association Annual Conference, March 9–13 in Orlando, Fla. “It’s a really amazing time to be in health care,” said Jean Stumpf, the project manager for PHS’s Education Department, who will present the case study. “With advancements in technology we can now safely and effectively train healthcare professionals using online education, something we weren’t able to do years ago.” PHS has been creating online courses for clinicians since 2014.

Rehab Medical named best place to work

Honor follows overhaul of ‘employee experience’ last year

INDIANAPOLIS – Rehab Medical has been selected as one of Indiana’s best places to work by the Indiana Chamber of Commerce.

The statewide survey and awards program is designed to identify, recognize and honor participating employers in Indiana with leading workplace cultures. Rehab Medical is one of 37 companies to be recognized in the medium-sized category, with final rankings to be unveiled April 30.

The company, under the direction of Alisshia Isaacs, director of human resources, overhauled its “employee experience” last year by adding an Employee Development Program through a partnership with trueU. It also launched a new annual program that recognizes four employees for exemplifying its core values of “showing compassion, being energetic to achieve and displaying hard work with balance” and gifting them all-inclusive trips.

Other enhancements to the “employee experience” at Rehab Medical include two paid days for philanthropic events, a wellness plan that provides discounts on monthly health insurance premiums and a tuition reimbursement program.

Additionally, the company renovated its corporate office to include huddle rooms, collaboration rooms with Nintendo Wiis and a stocked break room.

In 2018, Rehab Medical was named a “Top 25 Fastest Growing Companies” in Indianapolis by the Indianapolis Business Journal and received an A+ rating from the Better Business Bureau for its customer service.

Medtrade Spring: First time exhibitors, Early Rates

Medtrade Spring show organizers report about 40 first time exhibitors will be at the expo this year. “Companies are seeing opportunities in the DME industry,” said Kevin Gaffney, vice president and group show director. “They also see value in the exposure that is possible at Medtrade Spring.” First time exhibitors include United Medical Credit, an Irvine, Calif.-based provider of medical loans, and Sleep 8 Inc., a Brentwood, Tenn.-based maker of a CPAP sanitizer. Medtrade Spring is April 16-18 at the Mandalay Bay Convention Center in Las Vegas…Early Rates for Medtrade Spring are in effect until Feb. 23. Under these rates, an expo pass is $50 and a conference pass is $199. Add-ons are also available at reduced prices until Feb. 23, including the Rise & Retail Breakfast Roundtable for $75.

https://www.medtrade.com/home/

QS/1 partnership enhances patient communications

SPARTANBURG, S.C. – QS/1 has partnered with Digital Pharmacist to offer secure, HIPAA-compliant ways for pharmacies to communicate with patients through a variety of platforms. The system allows patients to use personal devices like smartphones to request and receive information from pharmacies. Pharmacies can now leverage website and mobile applications to allow patients to submit refill requests directly to them and monitor the status of those requests. The system will also send refill reminders to help improve patient compliance.

People: Board appointments, new hire, new chair

AAHomecare has appointed three new members to its board of directors: Michelle Templin, vice president of legislative affairs and business development for Managed Health Care Associates; Jeff Bowman, vice president of home medical equipment for McKesson Medical-Surgical; and Todd Walling, senior vice president of sales for Permobil, Business Region Americas…AAHomecare has also hired David Chandler as director of payer relations. Chandler, currently director of reimbursement and government affairs for Liberty Medical Specialties, is a past-president and current treasurer of Atlantic Coast Medical Equipment Services Association…HOMES has named Sean Andrews as its new Maine State Chair. Andrews has worked at Bedard Medical in Lewiston for 11 years, including three as director of HME operations.