In brief: Initial appointments, guilty pleas, online showroom 

WASHINGTON - Liz Richter has been named acting administrator of CMS and Norris Cochran has been named acting secretary of the Department of Health and Human Services. 

Richter is an agency veteran who has worked at CMS since 1990, most recently as deputy center director for the Center for Medicare. She began in the Bureau of Policy Development working on inpatient hospital payment policy. She subsequently worked on a variety of Medicare payment issues. She has also served as director of the Hospital and Ambulatory Policy Group in the Center for Medicare Management. 

Cochran previously served as deputy assistant secretary of budget for HHS. 

President Joe Biden has nominated California Attorney General Xavier Becerra to serve as his HHS secretary but there has been no confirmation hearing scheduled yet. 

F&P sees increased demand due to COVID-19 surges 

AUCKLAND, New Zealand – Fisher & Paykel Healthcare reports operating revenue for the nine months ended Dec. 31, 2020, was up 73% in constant currency compared to the prior comparable period. 

In the hospital product group, operating revenue was up 113%, with hardware growing 446% and consumables growing 54%. 

“In many parts of the world, we have continued to see an influx of COVID-19 patients requiring hospitalization for respiratory treatment,” said Lewis Gradon, managing director and CEO. “Given the elevated hospitalization rates for COVID-19, our hospital hardware sales have continued to be very strong, as has the use of our hospital hardware.” 

In the homecare product group, operating revenue was up 6%.  

Due to the significant variability on a month-to-month basis for both the hospital hardware and consumables revenue, F&P says its previous guidance for fiscal year 2021 is outdated. The company now expects revenue and net profit after tax for FY2021 to be higher. 

F&P also made the following observations about the nine-month period: 

• Hospital hardware sales and usage continue to generally track local hospitalization surges in countries around the world 
• The volume of air freight continues to be higher than normal and freight costs remain elevated 
• In home care, OSA diagnosis rates continue to be reduced, offset by strong growth in our products used for nasal high flow therapy in the home 
• The company continues to progress the acceleration of investment in manufacturing capacity 

Two charged in $190M brace scheme 

BOSTON – Two women have pleaded guilty to charges they participated in a scam to defraud Medicare of more than $109 million by filing false claims for orthotic braces. 

Jessica Jones, 30, of Louisville Colo., and Elizabeth Putulin, 30, of Coconut Creek, Fla., who have each pleaded guilty to one count of conspiracy to commit health care fraud, conspired with their employer, Juan Camilo Perez Buitrago, to submit more than $109 million in false and fraudulent claims for DME, such as arm, back, knee and shoulder braces, according to the Department of Justice. Perez in October pleaded guilty to health care fraud and paying kickbacks in connection with a federal health care program. 

Jones and Putulin are charged with helping Perez submit false and fraudulent Medicare claims by establishing shell companies in more than a dozen different states, including Massachusetts. They purchased Medicare patient data from foreign and domestic call centers that targeted elderly patients and instructed call centers to contact the Medicare beneficiaries with an offer of ankle, arm, back, knee and/or shoulder braces “at little to no cost.”   

Jones and Putulin further facilitated the fraud, according to the DOJ, by answering frequent phone calls from Medicare patients who received DME that they did not request, want or need; and responding to requests from insurance companies for prescriber orders and medical records, which they were unable to provide. 

Jones and Putulin, who are scheduled to be sentenced on May 19, face up to 10 years in prison, three years of supervised release and a fine of $250,000. 

In 2019, federal agencies launched a nationwide takedown, “Operation Brace Yourself,” on a $1.2 billion fraud scheme involving medically unnecessary braces. 

OIG, CMS disagree on usefulness of certain CERT data 

WASHINGTON – CMS and its contractors did not use CERT data to identify providers with higher error rates, according to a new report from the Office of Inspector General. 

Using CERT data, the OIG identified 100 “error-prone” providers from 2014 through 2017. Of the $5.8 million reviewed by CERT, $3.5 million was incorrect, an improper payment rate of 60.7%. During the same period, Medicare made $19.1 billion in fee-for-service payments to those same providers. 

These providers had at least one error in each of the four years analyzed, an error rate of higher than 25% in each year, and a total error amount of at least $2,500, according to the OIG. An error-prone provider is statistically more likely to submit an improper claim than the average provider, the agency says. 

The OIG recommends CMS review the list of 100 error-prone providers identified and take specific action as appropriate, such as prior authorization, prepayment reviews and post-payment reviews, and use annual CERT data to identify individual providers that have an increased risk of receiving improper payments and apply additional program integrity tools to these providers. 

CMS did not concur with the recommendations, disagreeing with the OIG’s methodology. It also stated that it had previously tried to identify error-prone providers and suppliers using CERT data, but it found the data ineffective. 

The OIG reviewed CMS’s comments, but said its findings stand. 

AAHomecare updates: Sequestration, innovative tech, supplier costs, TRICARE 

WASHINGTON – Reps. Brad Scheider, D-Ill., and David McKinley, R-West Va., introduced have introduced H.R. 315, new legislation to continue the moratorium on the Medicare sequester cuts through the duration of the public health emergency. In December, Congress extended the pause on the 2% cuts, which were set to expire at the end of 2020, through March 2021…CMS published a final rule on Medicare Coverage of Innovative Technology and the Definition of “Reasonable and Necessary” on Jan. 14. The rule finalizes a new coverage program called “Medicare Coverage of Innovative Technology” to streamline “FDA-designated breakthrough medical devices” up to four years. It also codifies the “reasonable and necessary” definition with some modifications. The rule is effective March 15, 2021. See AAHomecare’s summary here…AAHomecare has developed a survey to demonstrate to CMS and legislators how much DME costs have increased since the payment rates from the last round of competitive bidding were established. Information will be confidential and only shared in aggregate. The deadline to submit a survey is Feb. 5…TRICARE West announced in December that it was automatically adjusting DMEPOS claims to reflect relief for providers included in the CARES Act from March 2020. As a result, providers no longer need to submit claim review requests for claims that qualify for these rate adjustments. Additionally, it announced that claims that were adjusted in error going back to Jan. 1, 2020 would also be reprocessed. 

OPGA launches new website 

WATERLOO, Iowa – The Orthotic and Prosthetic Group of America, a division of VGM & Associates, has launched a redesigned website at opga.com. The site makes it easier for members to find the information and resources they’re looking for with a new members-only portal. “At OPGA, we strive to provide savings and solutions to our members to help their businesses thrive,” said Todd Eagen, president of OPGA. “With the new website, we’re making it even easier for members to find the valuable information they need so that they can spend more time on what truly matters – their patients.” The redesigned OPGA website is part of a larger overhaul of vgm.com. The two together provide a one-stop shop for members serving both the orthotic and prosthetic, and HME industries. 

DarioHealth appoints digital health expert 

NEW YORK – DarioHealth has named Chris Chan senior vice president of employer sales, responsible for leading growth initiatives in the self-insured employer market. Chan previously worked as chief marketing officer at SleepQuest, a sleep apnea-focused technology and telehealth company, and he also founded the Mercer LABS and the Health Imagination Innovation Team at Willis Towers Watson. He has an extensive background in digital health, care delivery improvement, behavioral economics and incentive design. "Chris brings an extensive network of senior-level relationships and a successful track record of innovation and sales leadership in digital therapeutics, and we are very pleased to welcome him to the team," said Rick Anderson, president and general manager of North America. "In his previous roles, he has been involved in the proliferation of some of the largest digital health interventions in the employer and payer markets.” 

RehabPulses takes showroom online 

MIDDLETON, Wis. – RehabPulse, an online marketplace for mobility and home medical equipment, has launched a virtual showroom for wheelchairs and scooters. Users can book an appointment for a video conference with a support specialist to view options and customize wheelchairs. The seamless process then allows the user to check out with the click of a button. Rowheels, a manufacturer of manual, electric and power wheelchairs, launched RehabPulse to increase access to its wheelchairs. Other companies, including McKesson, Compas Health, Ki Mobility, Merits Health, joined the marketplace last year.  

RESNA seeks board noms, ATP volunteers 

ARLINGTON, Va. – The deadline for nominations to fill three seats on RESNA’s board of directors is Feb. 15. Candidates must be a RESNA member in good standing for a period of three years immediately preceding their nomination. It is also preferred they have a history of participation in and contribution to RESNA organizational activities. The Governance Committee will review nominations and forward proposed candidates to the board of directors for consideration at its spring meeting. After approval by the board, RESNA will make the online election system available to its membership…RESNA seeks assistive technology professionals for various exam development activities and enhancements to the ATP exam. ATPs must be in good standing and be willing and able to sign conflict of interest and confidentiality statements. Selected volunteers will be contacted on a rolling basis throughout 2021. FMI, contact Lindsey Sullivan, certification manager at lsullivan@resna.org. 

Insulet launches OmniPod DASH in Canada 

ACTON, Mass. – Insulet’s OmniPod DASH Insulin Management System is now available in Canada. The system combines a tubeless, wearable, waterproof Pod with an easy-to-use, touchscreen Personal Diabetes Manager. The PDM features an intuitive interface that allows customers to wirelessly control the Pod to deliver customizable basal rates and bolus amounts. “We’re thrilled to bring this convenient and easy-to-use insulin delivery system to Canada,” said Bret Christensen, chief commercial officer of Insulet. “The Omnipod DASH System’s Personal Diabetes Manager (PDM), combined with the existing benefits of Pod therapy, will provide Canadian users even more freedom, flexibility, and discretion to simplify their diabetes management.” 

Medisafe launches digital health resources 

BOSTON – Medisafe, a digital therapeutics company with 7 million registered users, has announced a new initiative with Everyday Health to launch new condition-specific resource centers through the Medisafe platform. With 40% of patients turning to digital resources to help manage their chronic conditions, the new digital resource centers will feature health care guidance, condition-specific news coverage and living-with information to support patients managing their condition, including heart health, cholesterol, migraines, mental health and several oncology specialties. In June, Medisafe launched a COVID-19 digital resource. “Medisafe users continue to rely on our platform for regular updates since we first deployed Everyday Health’s sponsored COVID-19 Resource Center, demonstrating an increased need for centralized resource centers that support many common conditions,” said Medisafe CEO Omri Shor. “With more patients using digital health tools to manage their health conditions, we’re excited to expand our platform to present patients with a trusted resource in their pocket and make living with an illness one less worry in the day.”   

Chart Industries to move to NYSE 

ATLANTA – Chart Industries announced Jan. 18 that it plans to transfer the listing of its common stock to the New York Stock Exchange from the NASDAQ stock exchange effective Feb. 1, 2021. The stock will continue to trade under the ticker symbol GTLS and will continue to trade on the NASDAQ until the transfer is complete. “We are pleased to join the NYSE, the world’s largest stock exchange with world-class listed companies, to further reach global investors and shareholders,” said Jill Evanko, Chart’s CEO and president. “With four of our top five customers also listed on the NYSE, we believe this will enhance our exposure to them and further develop new and existing partnerships.” On the day of the announcement, Chart Industries was priced at $134.88 per share on the NASDAQ, with a market cap of $4.86 billion. 

Registration for Provider Relief Fund reporting begins 

COLUMBIA, S.C. – The Provider Relief Fund Reporting Portal is open, but right now, providers can only register on the website, according to MiraVista. The Department of Health and Human Services hasn’t specified when reporting features will be available, but providers that received more than $10,000 from the PRF should register now to receive email notifications and updates, the consulting firm says. Because the portal times out after 15 minutes of inactivity, MiraVista recommends that providers collect the following information before beginning: tax identification number; business name and address of the reporting entity; name, phone number and email of the responsible submitter; and TIN for each subsidiary, if reporting on behalf of subsidiaries. Registrants must also verify their identity with the following details of the RFP payment: TIN of entity that received the payment; payment amount; mode of payment (check or deposit ACH); and check number or ACH settlement date. Once the portal is fully functional, recipients will likely have 30 days to report eligible expenses incurred through Dec. 31, 2020, according to MiraVista. If reported eligible expenses and losses don’t exhaust PRF receipts by June 30, 2021, providers will have to return unused funds, it says. 

Sleep8 lowers MAP, wholesale pricing 

YARMOUTH, Maine – Sleep8 has decided to extend a lower minimum advertised price for its CPAP sanitizing devices throughout 2021. The company lowered its MAP to $199 from $249 in December to help its DME provider customers boost end-of-year revenues, resulting in “significant sales across all of our partners,” the company says. “We spent more time and energy than ever before on supporting (DME providers) through this turbulent season,” it says. “The new strategies and innovations that were developed in 2020 - will continue to remain front and center in the new year.” Sleep8 has also revised wholesale pricing to $109 price per unit for one case and $99 price per unit for more than two cases. To help DME provider customers boost revenues further, Sleep8 has also developed new co-branded email content and offered staff training. 

NSM buys Scooters N More 

NASHVILLE, Tenn. – National Seating & Mobility has acquired Scooters N More in Valparaiso, Ind., expanding access to mobility solutions throughout Northern Indiana and the Chicago metropolitan area. “Our growing footprint supports our commitment to deliver 360-complete mobility solutions to more individuals who need them,” said Bill Mixon, NSM CEO. “We look forward to expanding the availability of innovative products, breakthrough technologies and best-in-class services supporting independence throughout Northern Indiana.” Scooters N More, founded in 1998 by John Frantom, is an approved vendor with several Veterans Affairs facilities. In addition to boosting NSM’s VA Business, the acquisition creates an opportunity to further enhance its independent living program with The Home Depot. Announced last fall, the program offers solutions to support Home Depot customers looking to create a safer environment. 

NHIA names fellows for new program 

ALEXANDER, Va. – The National Home Infusion Association has announced the members of its inaugural Fellow Program. The program aims to advance the home and specialty infusion profession by recognizing the contributions and achievements of highly accomplished individuals. NHIA fellow status is awarded to members who have successfully demonstrated a commitment to the field of home infusion for at least seven years, have a record of sustained involvement and leadership within NHIA, and have been actively involved in educating practitioners and others. Those selected for the program are Kathi Andrusko-Furphy, Monica Bandy, Marianne Beuhler, Stan Chamallas, Gene Decaminada, Don Filibeck, David Hirsch, Suzanne Kluge, Nancy Kramer, Melissa Leone, Jeanne Lugli, Ramona Moenter, Linda Payne, Barbara Petroff, Felicia Schaps and Paula Zelle. Those selected were part of a competitive application process, which included an extensive review of their professional accomplishments and letters of recommendation. The program is administered and funded by the National Home Infusion Foundation, thanks to a contribution from Integrated Medical Systems, the 2021 sponsor of the program. 

NCPA sues HHS over fees 

ALEXANDRIA, Va. – The National Community Pharmacists Association has filed a federal lawsuit against the U.S. Department of Health and Human Services over direct and indirect remuneration fees that it says are driving small business neighborhood pharmacies out of business. The lawsuit alleges that the fees are without reasonable transparency, and they conceal from patients and taxpayers the true cost of prescription drugs. “Pharmacy clawbacks are fundamentally dishonest and unfair for patients and pharmacies, and they make it impossible for pharmacies to predict their costs,” said NCPA CEO B. Douglas Hoey. “Sixty percent of community pharmacies believe they may go out of business in the next two years if the clawbacks are not addressed.” The case, NCPA vs. Azar, was filed in the U.S. District Court for the District of Columbia. In its complaint, the NCPA argues that a rule allowing price concessions to be imposed on pharmacies long after the point of sale violates the language and intent of the Medicare Act. The lawsuit highlights an exception included in a CMS rule that states all negotiated prices must include price concessions from network pharmacies except those contingent price concessions that cannot reasonably be determined at the point of sale. A recent study cited in the complaint showed that pharmacy DIR fees have increased 1,600% since 2015, with $4 billion in DIR fees being squeezed from pharmacies in 2017 alone.