Pulmonologists blacklisting providers? Beneficiaries taking CPAPs hostage? The crazy world of compliance.

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12/08/2009

It's been just over a year since Medicare's new compliance requirements went into effect for CPAP. Over the past year, I have checked in regularly with CPAP providers to see how its going. For the most part, providers take the good with the bad and simply try to take care of patients. However, I never fail to be amazed at the disconnect between Medicare/physicians/beneficiaries, with the provider stuck firmly in the middle.
Kelly Riley, director of the MED Group's National Respiratory Network forwarded me this latest example from a provider:
We have had patients that have not been compliant at the end of the 91 days. When presented with the available options at the end of the trial period we have had a local pulmonologist tell us that if we picked up the patient's equipment (they were unwilling to order a new sleep study, DC or change the patient to bilevel) that … we would never receive another referral from them again and become "blacklisted".  They did not care what the Medicare rules were. Keep in mind that the patient is unwilling to sign an ABN and refused to voluntarily return the equipment because she says the Dr wants her to have it. This is putting the dealer in a catch 22 situation.  Can we get guidance from the Medical directors on what to do when this happens?  I believe there needs to be some recourse to the physician in a case like this.
This provider raises some good points. Is it fair for physicians to, essentially, threaten providers with blacklisting? Is it legal for a beneficiary to hold CPAP equipment hostage? Isn't that ... stealing?

Providers, what else are you experiencing?

Theresa Flaherty