Providers call out OIG for unnecessary report

Wednesday, July 3, 2013

WASHINGTON – HME providers wonder why an Office of Inspector General (OIG) study that compares Medicare and Medicaid replacement schedules for CPAP supplies was even conducted.

The OIG recommends that CMS review and revise its replacement schedule for CPAP supplies, based on the lower frequencies it found in many Medicaid programs. But CMS in 2012 already cracked down in this area by requiring that providers prove supplies are no longer functional before they replace them.

“The DME MACs already addressed that,” said Eric Parkhill, vice president of clinical operations/corporate compliance for Home Medical Professionals in Gainesville, Ga. “We have to prove there was something wrong with the frame before we can replace it.”

In the report, released June 26, the OIG examined the replacement schedules of 50 fee-for-service Medicaid programs and found that, in 2012, 39% had lower frequencies than Medicare; 51% equaled Medicare; and 10% exceeded Medicare.

Even CMS did not concur with the OIG’s recommendations. It stated that failure to consider noncompliance or the potential impact of supplier fraud or abuse would bias the estimate of a clinically appropriate refill rate.

More frequent replacements go hand-in-hand with patient compliance, say providers.

“The patients who are more compliant are more diligent about replacing their supplies,” said Eric Cohen, president and co-founder of Concord, N.H.-based National Sleep Therapy.

Furthermore, providers say they already toe the line when it comes to how frequently they replace items. Medicare’s local coverage determination (LCD) allows for supplies like cushions, headgear and tubing to be replaced anywhere from every month to every six months, depending on the item.

“We don’t give anybody anything unless they need it,” said Glenn Steinke, owner of Airway Medical in Bishop, Calif.

The OIG argues that revising the replacement schedule for CPAP supplies would result in significant savings. If Medicare reduced the frequency of mask replacements to one mask every six months, for example, it would reduce expenditures by $14.2 million or 14%. But with competitive bidding set to start July 1, Medicare’s already going to save plenty, providers say.

“Competitive bidding is going to change everything, anyway,” said Helen Kent, president of Carlsbad, Calif.-based Progressive Medical. “What difference does it make?”


It's business. Medicare is officially a business just as every other health care payer.   The days of provider patient health care to benefit the patient are over.  The mentality for health care payers is lower the price first then reduce consumption.  The old one-two punch!  HMO's and managed care companies became most successful lowering the reimbursement to health care Providers using the carrot guaranteeing Providers accessibility to Patient groups (offering volume sound familiar) then limited those services the HMO's and Managed Care Companies paid!  HMO's and Managed Care Companies had a wild card to add.  They, in order to enhance their bottom line began increasing the premiums to it's members.  So HMO's get a one-two-three punch.  Similar to "Cinderella Man" (Paulk Giamatti's bop-bop-bam!).  I would anticipate a similar upward shift in both the medicare premium and deductible to follow in the not to distant future!  Giving them a one-two-three-four punch!