Tag: Mail order diabetes supplies

STUART, Fla. – Ted Albin, a reimbursement consultant who provided services to Arriva Medical, and his firm, Grapevine Billing and Consulting Services, have agreed to pay $50,000 to resolve allegations they violated the False Claims Act, according to the U.S. Department of Justice.  In an emailed statement to HME News, an attorney representing Albin and Grapevine, said the case was without merit. "Mr. Albin and Grapevine did nothing wrong, and they should never have been part...

WASHINGTON - The top two strips accounted for 53% of the Medicare mail-order market, and the top 10 strips accounted for 98% of the market, according to a new report from the Office of Inspector General.Overall, suppliers in Medicare's national mail-order program provided 17 types of test strips during the three-month period between April 1, 2018, and June 30, 2018, the OIG found.To conduct the report, the OIG sampled 1,210 claims from a population of 313,704 claims.Suppliers must comply with a rule...

YARMOUTH, Maine - If CMS decides to extend current competitive bidding contracts, a slight majority (53%) of respondents to a recent HME Newspoll say they would accept them—reluctantly.“We currently have the contract and have provided the equipment and services, so it just makes sense to continue with it,” said one respondent to a recent HME Newspoll. “Either way, you lose.”Contracts for both competitive bidding and the national mail-order contract for diabetes are set...

This blog headline caught the attention of my Google alerts: Why Medicare's Attitude Toward Diabetes Could Kill Senior Citizens. The blogger has Type 1 diabetes and, judging by her picture, is nowhere near Medicare age. She is, however, concerned about the national mail-order program which she believes will reduce access to high-quality supplies. To be sure, the blog, which I wound up skimming because it's rather legnthy, hits on some critical points, including the AADE survey of contract suppliers...

CHICAGO - Many national mail-order contract suppliers aren't carrying the diabetes testing supplies beneficiaries get prescribed, says the American Association of Diabetes Educators (AADE).A recent phone survey conducted by the association found that none of the contract suppliers offer products with more than 50% market share, as required by the program, and only three of the suppliers carry all of the brands that they told CMS they would.“Our educators are concerned because they've been told...

NASHVILLE, Tenn. - A national provider of mail order diabetes supplies denies allegations that it has violated telemarketing laws in Missouri.The Missouri Attorney General's Office on March 15 filed a lawsuit against Simplex Healthcare, claiming that the provider violated the state's “No Call” list over a period of more than two years by calling residents who had signed up for the list, which is managed by the attorney general's office.“Simplex takes compliance with all laws very...

As a small business owner in the DME industry, I for one think it is about time CMS and Congress recognize the enormous disparity between mail order and non-mail order reimbursements (“Diabetes payments pushed off a cliff,” HME News, February 2013). Can someone give me a good argument/rationale to not level the playing field? Why is there now an outrage about how this is going to affect beneficiaries? Maybe it is just me, but it seemed less a concern when only mail order DME providers...

FLETCHER, N.C. - Marcus Suess won mail-order contracts for diabetes supplies in all nine competitive bidding areas in Round 1, but he says the jury's still out on how well the program works—for providers and beneficiaries. The president of All-States Medical Supply says there are some highs and lows that come with the mail-order contracts.The pricingGetting paid an average of 32% less is a challenge, Suess said. “We had to restructure some things and find where our inefficiencies were,”...

BALTIMORE - The new average sales price (ASP) figures for nebulizer medications released in September brought few changes. Albuterol (J7613) was down 2 cents to 13 cents per dose, while budesonide (J7626) was down nearly 11 cents to about $4.87 per dose. Levalbuterol (J7614) and ipratropium (J7644) stayed flat at 65 cents and just under 13 cents per dose, respectively. Brovana (J7605) was down almost 14 cents per dose to $5.22, and Perforomist (J7606) was up just more than 12 cents per dose to $5.21.ADW...

YARMOUTH, Maine - There's no official timetable, but it's unlikely CMS will drag its feet on pushing forward with its plan to use inherent reasonableness (IR) to reduce reimbursement for retail diabetes supplies, industry stakeholders say."I would expect a proposed rule sooner rather than later because they can implement this more quickly than competitive bidding," said Cara Bachenheimer, senior vice president of government relations for Invacare. "Once you have the proposed rule, then you hear the...