In brief: ZPIC conflicts of interest, IR meeting agenda

Friday, July 13, 2012

WASHINGTON – Companies that seek ZPIC contracts from CMS often have conflicts of interest that could compromise the integrity of the program, according to a new report from the Office of Inspector General (OIG). The OIG reviewed conflict-of-interest information for 18 such companies, called offerors, and 85 subcontractors and found that, while many had business and contractual relationships with CMS and other offerors, they didn't consider them conflicts of interest. They reported having relationships with CMS or contractors of CMS that provide Medicare Parts C and D plans, claims processing, program integrity, and/or quality improvement services. Currently, CMS requires that offerors disclose information about possible conflicts, but it does not have a formal policy for reviewing that information, according to the OIG. As a result, the OIG recommends, among other things, that CMS: provide clearer guidance in RFPs regarding which business and contractual relationships should be identified as actual conflicts and which should be identified as possible conflicts; state whether offerors and subcontractors need to report income amounts, periods of performance, and types of work performed for their contracts with CMS and income amounts generated from key personnel’s other employment; and create a standardized format for reporting information in the organizational conflict of interest certificate and require its use by offerors and subcontractors. To read the OIG’s report:

Meeting agenda: Is fee schedule for diabetes supplies ‘grossly excessive’?

BALTIMORE – CMS will use a July 23 public meeting with industry stakeholders to determine whether the current fee schedule for retail diabetes supplies is “grossly excessive,” the agency stated in a special note last week. Following the meeting, CMS will decide whether to pursue IR vs. competitive bidding to achieve more appropriate pricing for these items. “Decisions regarding whether to propose inherent reasonableness payment limits for these items and services, what data and pricing information to use, and when such limits would take effect will be examined by CMS and made after the meeting and would be included in a proposed notice for public comment published in the Federal Register,” the agency stated. The meeting will take place from 9 a.m. to 1 p.m. EST at CMS headquarters at 7500 Security Boulevard in Baltimore.

AAH criticizes fraud efforts

WASHINGTON – CMS's anti-fraud efforts are "confusing" and "subjective," AAHomecare stated in a July 6 letter to the Senate Finance Committee. "CMS’s current anti-fraud strategy employs auditors targeting conscientious providers who are having to refund millions of dollars to Medicare for failing to satisfy confusing, ambiguous, retroactive and subjective documentation requirements for items and services furnished to Medicare beneficiaries," the association stated. The Senate Finance Committee in May sought input from industry stakeholders and providers about anti-fraud efforts. It plans to continue gathering feedback from those who submitted comments and release a summary document with proposed best practices and ideas this fall.

Linde raises money, Lincare offers dividend

MUNICH, Germany – Linde AG has sold 12.8 million new shares to raise $1.7 billion to put toward its $4.6 billion purchase of Lincare Holdings, the industrial gas giant announced last week. The capital increase is only one way Linde plans to raise money. “We will continue to implement our financing strategy, which is geared toward safeguarding liquidity and adopting a long-term approach, a strategy which is rewarded by the rating agencies…Lincare last week offered shareholders as of market close on July 11 a dividend of 20 cents per share, according to news reports. At a price of $41.58 on July 11, the dividend will yield 1.9%. The average volume for Lincare has been 3.7 million shares per day over the past 30 days.

CMS: We improved PECOS

BALTIMORE – CMS has improved PECOS to increase access to information, the agency announced in a bulletin last week. Among the improvements: The layouts of the homepage and log-in screen have been redesigned to include helpful links to tutorials, the ordering and referring list and the revalidation notice sent list. Additionally, users will now see “revalidation notice sent,” “revalidation received” and “revalidation complete” dates displayed on their enrollment page. FMI:

Rotech’s Carter gives notice

ORLANDO – President and CEO Philip Carter has notified Rotech Healthcare that he plans to retire effective Dec. 31, 2012. Carter will remain on the provider’s board of directors. The board intends to initiate a search process to select Rotech’s next president and CEO and to engage an executive search firm to assist in the process of evaluating external and internal candidates. “On behalf of the board and the entire company, I would like to thank Phil for his extraordinary leadership over these past 10 years,” stated Arthur Reimers, chairman of the board, in a press release. “The company’s operations are well positioned for the future, and the company has a strong management team in place. Based on the transition plan the company implemented last year with the amendment of Phil’s agreement, the company believes we now have ample lead time for an orderly transition.”

GMEA buys A&A

PHOENIX – Global Medical Equipment of America (GMEA) has acquired A&A Medical Supply, a full-service DME provider covering the Baltimore-Washington, D.C., market. The acquisition allows GMEA to “begin penetration into the Mid-Atlantic region,” the company stated in a press release. “A&A enables us to expand into a strategic demographic with a solid company bringing much talents to GMEA,” stated Harold Halman, CEO of GMEA.

Noridian targets eight PWC codes for prepay review

FARGO, N.D. – Noridian Administrative Services, the Jurisdiction D DME MAC, will be initiating a widespread prepayment review of claims for eight power wheelchair codes. The codes: K0813, K0821, K0822, K0823, K0824, K0825, K0850 and K0861. Noridian is conducting the review based on the results of a CERT review analysis. Providers of the selected claims will receive an ADR letter asking for specific information to determine in the item billed complies with the existing reasonable and necessary criteria. Failure to comply within 45 days of the date on the letter will result in a denied claim. FMI:

OIG likes rebate progams

WASHINGTON – The Office of Inspector General (OIG) recently released a report stating that Indiana Medicaid had saved 50% by using manufacturer rebates for test strips. Indiana's maximum Medicaid reimbursement rate for the strips is $36.72. Through two separate contracts, net cost for the strips was reduced to $17.72 or $14.70 per 50-unit pack. Overall savings: $1.2 million from Jan. 1, 2011 through June 30, 2011.

Short takes: Medline, ResMed, Uplift Technologies

Mundelein, Ill.-based Medline Industries has been named one of “Chicago’s Best and Brightest Companies to Work For” based on its human resources practices and commitment to its employees. An independent research firm evaluated the company using a number of measures, including compensation and benefits, employee engagement initiatives, and recognition efforts…San Diego-based ResMed has launched a new ResMed Online Store ( The company has updated the site to simplify the process of ordering products and to improve the overall purchasing experience. Features include a product availability tool, a quick entry function and an order history capability…Ancor Capital Partners and Merit Capital Partners have acquired Canada-based Uplift Technologies, a manufacturer of light therapy products. Uplift will operate through Carex Health Brands Canada, a division of Boston-based Carex Health Brands.

People: VGM, NST

VGM & Associates has named Clint Geffert to the newly created position of national vice president of sales. Previously, Geffert worked for Philips Respironics for 14 years. His most recent position at the company: director of sales for national accounts…National Sleep Therapy has named Joseph Zangrilli vice president of operations. He will lead day-to-day operations and manage the company’s continuing growth. Additionally, he will focus the company on ACOs and institutional and larger scale utilization programs.