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In brief: 2022 HME WOY, new ICD-10 codes, orthotics fraud

In brief: 2022 HME WOY, new ICD-10 codes, orthotics fraud

WATERLOO, Iowa – Sherry Krug, vice president of business development at Binson's Medical Equipment & Supplies, has been named the 2022 HME Woman of the Year. 

Krug, who joined Binson’s in 2020, oversees operational functions for all of the company’s locations 

“Thank you,” she said during an online event on Dec. 15 hosted by the VGM Group to celebrate the finalists and name the winner. “This is such an honor and beyond any expectation that I had. The women that are here today are so special and all so deserving of this award." 

Krug has expertise in HME operations and specializes in respiratory and COPD programs. Binson’s growth and development is supported by her ability to lead teams through complex projects with a focus on quality, compliance and cost savings.  

“It is an honor and a privilege for me to be able to present this award to Sherry today,” said Mike Mallaro, CEO of VGM Group. “Sherry serves as a role model for women currently in the industry and sets a standard for generations to come. I’m thrilled to see what she will accomplish next in the industry.” 

The other WOY finalists were: 

  • Dalia Morales, ATP, director of compliance, HR, and complex rehab technology at Respiratory and Medical Homecare Unlimited; 
  • Sheila Roberson, chief compliance officer of Great Elm Healthcare; and 
  • Erin Weiman, CEO and owner/operator of Nunn’s Home Medical Equipment. 

VGM received nearly 50 nominations for the award this year. 

AAH offers fee schedule analysis 

WASHINGTON – AAHomecare’s analysis of the top 24 DME items show an average rate increase of 6.4% for competitive bid items in bid areas, with a range of 5.1% to 7.5%. 

Bid items in non-rural areas have an average increase of 8.7% (ranging from 6.3%-10.2%); and bid items in rural areas will increase 8.4% (ranging from 4.2%-8.9%).  

CMS published the 2023 Medicare DMEPOS fee schedule on Dec. 14. The fee schedule reflects the 6.4% to 9.1% CPI-U adjustments published earlier this month.  

Are health plans prepared for increased demand for home care services? 

MIRAMAR, Fla. – There’s a growing recognition among health plan leaders of the value of delivering health care within the home, according to the results of a survey conducted by Integrated Home Care Services. 

Ninety-one percent of the 47 health plan leaders surveyed say demand for home care services has risen over the past five years – and they expect that trend to continue. The majority of leaders also say home care costs have increased, with one-quarter saying they have increased more than 10%. 

"Nationally, there continues to be a significant growth in demand for home care services," said Christopher Bradbury, CEO of IHCS. "This is not surprising, given the surging senior population, the popularity of home care, the advances in homecare-related technology and the significantly lower costs of home care services when compared to facility-based care." 

Among other key findings in the report: 

  • 80% predict the increase in home care utilization is permanent. 
  • Only 38% say their organization is performing "very well" when it comes to supporting the home care needs of plan members, while 60% say they do this "moderately well." 
  • Nearly two-thirds say executives meet rarely or occasionally to discuss home care. 
  • 75% say reducing the administrative burden of home care is a top benefit of delegating services to a third party. About 50% say improving service coordination is a key benefit. 

"With the increasing demand for home care services, health plans are increasingly looking for new approaches to improve timely access to care, clinical outcomes, patient satisfaction and overall affordability," said Bradbury. "Fortunately, there is significant innovation taking place, not only in home-based quality of care, but also in improving the patient experience and delivering significant savings. Technology, clinical excellence, data insights, deeper care coordination, and value-based arrangements are driving forces around many of the innovative and effective approaches used by health plans." 

IHCS is an independent home care benefits administrator of home health, DME and home infusion services. 

ATHOMES announces board changes, date change 

CARY, N.C. – Rick Clark, a charter and founding member of ATHOMES, is stepping down from the board, the association announced in a bulletin. He also served as ATHOMES treasurer. Sharon Pruitt will take over the role of treasurer. ATHOMES also announces that Carrie Gibson of Rhythm Healthcare has joined the board. “I now work on the manufacturing side but previously had 15 years of experience in DME,” said Gibson. “I have broad background in DME from customer service, billing, accounts payable, operations manager, sales and sales manager. I am eager to help grow the organization to be able to provide customers as much information as possible.” ATHOMES has also bumped up the start date of its spring conference by a day, to April 18. FMI: 

ABM adds Tom Hill to board 

EAGAN, Minn. – ABM Respiratory Care has appointed Tom Hill to the company's board of directors. Hill, CEO and board member of Marketlab, brings decades of experience in corporate leadership and health technologies, and a strong track record of leading product development and diverse teams around the world. "We are delighted to bring Tom onto our board, which we have carefully crafted to guide the rapid growth of ABM Respiratory Care,” said Peter H. Soderberg, chairman of the board. "Tom adds to our collective experiences deep global experience in building durable supply chains, tremendous knowledge and relationships in medical products commercialization in the U.S. and China, and current expertise in product and service differentiation through digital strategies.” Hill previously served as president, manufacturing, at Direct Supply, where he led the company's private label brand portfolio, home health business and DS smart connected clinical platform. 

WHILL launches mobility service at Winnepeg airport 

SAN FRANCISCO – WHILL, a developer and service provider of power mobility chairs, has announced the first permanent installation in North America of its autonomous mobility service at Winnipeg Richardson International Airport. The WHILL autonomous mobility service relieves airlines of fulfilling wheelchair push demands and allows airline passengers to travel more freely by autonomously transporting them to their gates. “Accessibility is a global issue," said Kerry Renaud, CEO of WHILL North America. "WHILL products and services are uniquely designed to reduce barriers and improve the quality of life for our customers, and the partnership with Winnipeg Richardson International Airport will influence and expand mobility globally by raising the standard of reliable accessibility in public spaces." After the user selects their destination on a touch screen, the WHILL autonomous power chair proceeds to transport the passenger safely and reliably to the desired gate. The service covers the entire route from check-in counter to security checkpoint, and then to the departure gate to provide a seamless travel experience. 

New ICD-10 codes take effect for mobility devices 

WASHINGTON – An updated policy article for wheelchair seating that went into effect on Oct. 1, 2022, includes additional ICD-10 codes that will allow Medicare beneficiaries with certain diagnoses to obtain the seating products that they require. The codes were requested by the Clinician Task Force. The codes and diagnoses are: F03 - Unspecified Dementia Group 2 and Group 4 G31.83 - Dementia with Lewy bodies Group 2 and Group 4 G60.0 - Hereditary Motor and Sensory Neuropathy Group 2 Q72 codes - Congenital complete absence of lower limb or of thigh and lower leg with foot present Group 3 and Group 4 Q79.60-Q79.69 - Ehlers-Danlos Syndrome Group 2 and Group 4 Q90.0, Q90.1, Q90.2, Q90.9 - Down Syndrome Group 2. In addition, the updated ICD-10 codes include various types of muscular dystrophy. “This is excellent progress for those who require more than a general use seat or back cushion,” said CTF. “Please keep in mind that the ICD-10-CM code alone does not confer coverage; rather, the clinical findings manifested by the beneficiary must be documented in the medical record to support the medical necessity.” 

Hannibal Medical Supplies moves locations 

HANNIBAL, Mo. – Hannibal Medical Supplies will hold a Chamber of Commerce ribbon cutting and open house Dec. 15 to celebrate its move to 6464 Interstate Court in Hannibal. The store specializes in respiratory care, such as CPAP/BiPAP therapy, home oxygen and nebulizers. Hannibal Medical Supplies also carries medical equipment and supplies including hospital beds, power recliner/lift chairs, wound care, enteral products (liquid nutrition), bath safety equipment and a variety of other products designed to help people be as active as possible in their own home. 

Medline expands portfolio of mobility products 

NORTHFIELD, Ill. - Medline has expanded its portfolio of mobility products to include the new byACRE Overland Carbon Fiber Rollator, a lightweight assistive walking device durable and agile enough to operate in snow, sand and mud, as well as on sidewalks, curbs, unpaved trails and thick grass. "We wanted to create a rollator that aligns with people's hopes and dreams," said Anders Berggreen, founder and owner of byACRE. "When you get challenged on your mobility, it shouldn't be the rollator that limits you, it should only be your imagination. With an Overland Carbon, it's only up to you." Medline has served as the exclusive North American product distributor for byACRE, a Copenhagen-based designer and producer of mobility products, since 2021. Features of the Overland Carbon Rollator include light weight (less than 15 pounds), a shock-absorbing frame and integrated brakes with cables hidden in frame. 

React expands Luna’s scope beyond SDB 

SARASOTA, Fla. - React Health has announced 510(k) clearance from the U.S. Food and Drug Administration for the Luna G3 Bilevel S/T 30Vt as a non-invasive ventilator. This expands the utilization of the device beyond the sleep disordered breathing (SDB) market into management of chronic respiratory conditions. “We are pleased the FDA has approved the expanded use of the Luna as a non-invasive ventilator,” said Clint Geffert, president of commercial operations. “React remains committed to the successful treatment of chronic sleep and respiratory diseases and this approval further strengthens our offerings to help improve the lives of millions of patients suffering from these conditions.” Geffert says Luna joins a growing portfolio of respiratory products at React and offers prescribers and providers options at a time when recalls and supply chain challenges have impacted equipment availability. React was formerly 3B Medical. 

Dexcom partners with digital pharmacy 

TORONTO – Dexcom has announced a partnership with The Health Depot digital pharmacy to provide Green Shield plan members with convenient access to the Dexcom G6 rtCGM System and virtual diabetes coaching support. Green Shield plan members eligible for Dexcom G6 rtCGM coverage who register for the new Digital Diabetes Care Program, delivered by The Health Depot, will have exclusive access to automated product shipments, preferred pricing, direct billing, co-payment assistance, no-cost receivers, individualized diabetes management support and clinical consultation. “The Digital Diabetes Care Program will provide Dexcom rtCGM users with personalized care and glucose management support from our team of clinical pharmacists,” said Andy Donald, president of The Health Depot. “As a clinical pharmacy, The Health Depot specializes in helping patients better manage chronic diseases like diabetes, all from the comfort and convenience of home. We're thrilled to be able to help Green Shield plan members reduce the effort and cost it takes to manage this condition as part of this comprehensive solution with Dexcom." Dexcom G6 uses a small, wearable sensor and transmitter to continuously measure and send glucose levels wirelessly to a smart device or receiver, giving patients real-time glucose data without the need to scan or prick their finger routinely. The system has customizable and predictive alerts and alarms to help avoid potentially dangerous low and high blood sugar events and a function that allows patients to share their glucose data in real time with up to 10 followers. Dexcom G6 also offers connectivity through integrations with leading insulin delivery systems and digital health apps. 

BOC names Terri McLeod award winner 

OWINGS MILLS, Md. - The board of directors of the Board of Certification/Accreditation (BOC) has named Theresa “Terri” McLeod, CMF, COF, as the 2022 recipient of the Jim Newberry Award for Extraordinary Service. The award recognizes outstanding individuals who perform extraordinary service to BOC, the community of stakeholders the organization serves and those who live out the superior example modeled by Newberry during his more than four decades in the field of orthotics and prosthetics. “Terri has shown the same kind of passion for and commitment to BOC that defined our good friend Jim Newberry,” says BOC’s president & CEO Claudia Zacharias, MBA, CAE. “Our board is proud to award her with this honor.” John Kenny, PhD, BOCO, a past Newberry Award winner and former chairman of the BOC’s board of directors, nominated McLeod, who was trained as a BOC Certified Mastectomy Fitter (CMF) by Newberry himself in 1985, for the award. Beginning in 2005, she served as a test development volunteer for BOC CMF exams and, in 2007, she joined the board of directors, where she lent her expertise for nine years. When CMS began requiring mastectomy fitters to obtain certification in 2009, McLeod guided others in her profession toward certification so they could continue providing patients with the fittings they needed. 

Northern Light Pharmacy expands 

WATERVILLE, Maine – Northern Light Pharmacy has opened a new location here that features free local delivery, drive-thru pickup and a storefront stocked with DME, including canes, walkers, wheelchairs, braces and bathroom safety devices. The pharmacy also partners with Northern Light Inland Hospital to offer bedside delivery to inpatients. “We know that having access to medications and other medical equipment is an important part of patient care,” said Matt Marston, vice president and chief pharmacy officer of Northern Light Health. “We look forward to offering a variety of pharmacy services to the greater Waterville area.” Northern Light Pharmacy will host an open house at the location on Dec. 15, with the opportunity to win a grill and to talk to experts about vaccines. Northern Light Health is Maine’s only integrated health care system, comprised of 10 member hospitals, eight nursing homes with 585 long-term beds, five emergency transport members and 37 primary care locations. It provides care to people from Portland to Presque Isle and from Blue Hill to Greenville, employing more than 12,000. 

LUCI debuts Sandbox 

NASHVILLE, Tenn. – LUCI has opened up its platform to leading developers and research partners through a new program called LUCI Sandbox. Sandbox makes the LUCI platform and developer tools available to select organizations and institutions, allowing them to use the company as a research hub to accelerate innovation. “We created LUCI to solve real problems that exist for wheelchair users now, and Sandbox is another way for our team to collaborate with likeminded peers who are committed to doing the same,” said Jered Dean, co-founder and chief technology officer of LUCI. “By providing the expertise, application programming interfaces (APIs), software development kits (SDKs), and hardware that these partners need, we can all build to users’ needs, together. Sandbox will continue to grow, expand and bring needed change over time, dramatically accelerating what’s possible for the entire industry.” LUCI recently supported at least seven different grant proposals, including proposals from the National Science Foundation (NSF), National Institutes of Health (NIH) and the Administration for Community Living (ACL), to use Sandbox. The company notes that, while this type of research and developer access is common in other industries, through popular developer programs like Apple Healthkit and industry-university partnerships, Sandbox is the first program of its kind in power mobility. “We’re thrilled to launch LUCI Sandbox, but the truth is, this announcement is more about formalizing a lot of the collaborative efforts we already have in place,” said Barry Dean, LUCI co-founder and CEO. “We are a company fueled by collaboration, and we’re excited to take that company-wide commitment to the next level with this important program.” 

TwelveStone opens new infusion center 

MURFREESBORO, Tenn. – TwelveStone Health Partners has opened a new infusion center at Skyline Medical Center in Murfreesboro, Tenn. It’s the company’s 8th location, joining existing centers in Mount Juliet, Knoxville and Chattanooga, as well as Canton, Ga., and Roanoke, Va. “This is our first Infusion Center built near a hospital system and we are grateful for the opportunity," says Shane Reeves, chief executive officer, TwelveStone Health Partners. “We look forward to offering those living in north Nashville a convenient site for infusion services along with a higher level of care.” TwelveStone plans to open additional sites across the Southeast in 2023 to meet the needs of patients with chronic, complex and rare diseases that prefer convenient locations close to their homes. The company says it offers patients an enhanced experience with private suites, entertainment like TV and Wi-Fi services, and drinks and snacks. 

Two sentenced for orthotics-related fraud 

TAMPA and RALEIGH, N.C. – Ruth Bianca Fernandez has been sentenced to three years in prison for her role in a conspiracy to commit health care fraud and for making a false statement in a matter involving a federal health care benefit program. Government officials say Fernandez, who worked directly under Patsy Truglia, who has already been sentenced, and other conspirators generated medically unnecessary physician orders via their telemarketing operation for certain orthotic devices—knee braces, back braces, wrist braces and other braces. Through the operation, the personal and medical information of Medicare beneficiaries was harvested to create unnecessary orders. The orders were then forwarded to purported “telemedicine” vendors that, in exchange for a fee, paid illegal bribes to physicians to sign the orders, often without ever contacting the beneficiaries to conduct the required telehealth consultations. The fraudulent orders were then returned to Truglia’s telemarketing operation, which used the orders as support for millions of dollars in false and fraudulent claims submitted to Medicare. To avoid scrutiny, Truglia and Fernandez spread the fraudulent claims across five DME storefronts operated under Truglia’s control and Fernandez’s day-to-day management. In all, they caused approximately $25 million in fraudulent DME claims to be submitted to Medicare, resulting in approximately $12 million in payments…Tanya Grant, who led Carolina Rehab Products, also known as Atlantic Brace, and Blue File, has been sentenced to 80 months in prison for a health care fraud scheme she carrier out between 2017 and 2021. Government officials say Grant purchased lists of Medicare patient names from companies overseas and then billed Medicare for equipment that, in many cases, she never shipped. She also billed Medicare for equipment to 422 deceased individuals. In total, Grant used two companies to bill Medicare for more than $50 million in DME between 2014 and 2021, of which Medicare paid $17 million. She used the funds to purchase a home, multiple vehicles (including a Porsche), a boat, jewelry and electronics.


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