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In brief: CQRC on CMN, McKesson’s exit in Europe, fraud under spotlight

In brief: CQRC on CMN, McKesson’s exit in Europe, fraud under spotlight

WASHINGTON – The Council for Quality Respiratory Care in a statement today encouraged CMS to reconsider eliminating the CMN for home oxygen therapy. 

The CQRC, a coalition of the nation’s largest respiratory providers and manufacturers, says doing that would replace “objective testing ordered by a patient’s physician for the subjective decision-making of Medicare contractors.” 

“We are highly supportive of allowing acute patients to receive oxygen therapy outside the institutional or hospital setting; however, we are concerned CMS’s proposal would create ambiguity in the system when it comes to demonstrating patient need,” said Crispin Teufel, chairman of the CQRC. “While there have been difficulties with the objective CMN that established medical necessity, it has been an anchor during the appeals process when suppliers defend patients’ access to these devices after a contractor has denied their claims. It is essential that, if the CMN is removed, CMS adopts an objective template or prior authorization to make sure Medicare approves the patient access. A subjective review process and Medicare Administrative Contractor discretion, which, according to historic CMS CERT data, could result in 80% of claims being denied, (puts) patient access at risk.” 

CMS published a proposed decision memo earlier this month outlining the changes it wants to make to the NCD for home oxygen therapy. 

The CQRC is troubled by a more subjective approach because it could mean a supplier fills the physician’s prescription and delivers the equipment to the patient only for the Medicare contractor to deny the claim if the documentation does not meet their subjective view. The situation forces the supplier to try to remove the equipment from the patient’s home, even if the physician still believes, in their medical judgement, the equipment is necessary. 

“There is no reason to ‘hide the ball’ and make physicians, patients and suppliers guess at what documentation is required before contractors allow patients to use a device their physicians have prescribed for them,” Teufel said. “All stakeholders must have access to the objective data used to ensure the delivery of timely, quality patient care.” 

The CQRC said it plans to submit comments on the proposed changes before an Aug. 1 deadline. 

McKesson plans ‘full exit’ in Europe 

IRVING, Texas – McKesson has entered into an agreement to sell its European businesses in France, Italy, Ireland, Portugal, Belgium and Slovenia to the PHOENIX group. 

McKesson’s remaining European businesses in the U.K., Norway, Austria and Denmark are not part of the transaction, but the company says it is “exploring strategic alternatives” for those businesses, as it shifts the focus of future investments outside of Europe. 

“This transaction marks an important step in advancing McKesson’s commitment to streamline the business and prioritize investments in areas where we have deep expertise and are central to our long-term growth strategy,” said Brian Tyler, CEO. “We will continue to operate our remaining businesses in the U.K., Norway, Austria and Denmark, while also exploring a strategic path forward to full exit the European region.”  

The transaction also includes McKesson’s German-based AG headquarters in Stuttgart; Recucare GmbH, its German wound care business; its shared services center in Lithuania; and its 45% ownership stake in Brocacef, a joint venture in the Netherlands. McKesson will retain, however, its minority stake in its German join venture with Walgreens Boots Alliance. 

The transaction is expected to close in 2022. 

Feds highlight fraud efforts for FY20 

WASHINGTON – The Department of Justice opened 1,148 new criminal health care fraud investigations in fiscal year 2020, according to an annual report published last week. 

Federal prosecutors filed criminal charges in 412 cases involving 679 defendants. A total of 440 defendants were convicted of health care fraud-related crimes. 

The DOJ also opened 1,079 new civil health care fraud investigations and had 1,498 civil health care fraud matters pending at the end of fiscal year 2020. 

Investigative efforts by the Federal Bureau of Investigation resulted in more than 407 operational disruptions of criminal fraud organizations and the dismantlement of the criminal hierarchy of more than 101 health care fraud criminal enterprises. 

Investigations conducted by Office of Inspector General at the Department of Health and Human Services resulted in 578 criminal actions against individuals or entities that engaged in crimes related to Medicare and Medicaid, and 781 civil actions, including false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalties settlements and administrative recoveries related to provider self-disclosure matters. 

The OIG also excluded 2,148 individuals and entities from participation in Medicare, Medicaid and other federal health care programs.  

The report highlights a number of investigations related to DME on pages 16-17. 

ISS 2022 cancelled 

VANCOUVER, British Columbia – Sunny Hill Health Centre has cancelled the International Seating Symposium scheduled for March 2022 in Vancouver, British Columbia, due to “uncertain times” and the decision by its conference partner, Interprofessional Continuing Education (IPCE), to close. 

“The future format and way forward for ISS Vancouver is still under discussion,” Sunny Hill stated in an announcement on its website. “More information will be forthcoming.” 

The IPCE says it is winding down operations “due to circumstances beyond our control,” according to a statement from the organization. 

Sunny Hill thanked IPCE for many years of collaboration. 

ISS at the David L. Lawrence Convention Center in Pittsburgh will take place Oct. 28-30. 

Rehab Medical opens fifth location in Florida 

INDIANAPOLIS – Rehab Medical has opened a new office in Tampa, Fla., the next step in the company’s plans to expand its mobility services along the U.S. coastline. 

Rehab Medical opened its first location on the coast in Pensacola, Fla., nearly 10 years ago and has since opened locations in Winter Haven, Tallahassee, Orlando and now Tampa. 

“We are excited to open the Tampa office as part of Rehab Medical’s continued growth plan,” said Paul Martin, regional sales director. “This is only a small piece of the puzzle in our efforts to continue improving lives for as many individuals as possible.” 

The location in Tampa marks Rehab Medical’s fifth location in Florida and 26th nationwide. 

The company, headquartered here, serves more than 15,000 patients per year across 15 states. 

Patients warming up to remote monitoring devices, according to poll 

YARMOUTH, Maine – Sixty six percent of respondents say they are more willing to use a remote monitoring device now than before the COVID-19 pandemic, according to a poll conducted by GlobalData. Additionally, only 6% of respondents say they are less willing to use them due to efficacy concerns, indicating that the vast majority of patients are satisfied with the capabilities of remote monitoring devices, the poll shows. “The pandemic was likely the first time receiving care via video call or app for many patients,” said Dominic Tong, senior medical devices analyst at GlobalData. “The responses indicate that this experience was a positive one for most. Telehealth platforms allowed patients to conveniently receive care from the comfort of their own home, limiting the need for in-person visits. Remote monitoring devices would allow more thorough physician interactions and decisions, while still offering the convenience of at-home care.” Current remote monitoring devices include wearables such as the Apple Watch, which already has a number of health sensors built-in and has significant adoption. These devices are able to collect health data that would usually require an in-person visit. 

One Drop named Best Place to Work 

NEW YORK – One Drop, which has more than tripled its workforce in the past year, has been named one of the 100 Best Places to Work in New York City for 2021 by Crain’s New York Business. It’s the second consecutive year that the company has received recognition as an exceptional employer, ranked by leadership, culture, compensation and benefits. “Being recognized again as a Best Place to Work is particularly meaningful this year,” said Jeffrey Dachis, CEO and founder. “The quality of products that our organization delivered to One Drop clients and customers worldwide during such unprecedented times demonstrates how steadfast our employees are in their commitment to building healthcare solutions that are sustainable, equitable and accessible for all.” To select the winners, Crain’s, in partnership with Best Companies Group, reviewed weighted surveys from both employers and employees. One Drop maintains a flexible remote work policy, with its offices in New York and Austin, Texas, open to fully vaccinated employees. The company encourages team members to eliminate unnecessary meetings and take advantage of benefits like unlimited vacation days and an annual professional development stipend.   

Coming soon: LUCI on Sunrise wheelchairs 

NASHVILLE, Tenn. – LUCI’s smart wheelchair technology will be available to thousands of new users of Sunrise Medical’s popular QUICKIE line of power wheelchairs in September. “From the day LUCI launched, we have been eager to find a way to give our customers access to this industry leading technology,” said Larry Jackson, president of Sunrise Medical North America. “This partnership formed around the shared values and common goals of Sunrise Medical and LUCI, and we’re excited for the additional safety, security and independence we can now offer to power wheelchair users across the country to truly live without limits.” Teams at LUCI and Sunrise Medical have spent more than a year collaborating to make sure LUCI and QUICKIE work together as seamlessly as possible. They expect to announce further details on specific technology and products soon.

Motif leads product awards at Medtrade West 

PHOENIX – The BiliTouch Phototherapy Blanket from Motif Medical won the Providers’ Choice Gold Award at the New Product Pavilion at Medtrade West. The myCAIRE telehealth solution from CAIRE earned the Silver Award and the Ruby Skipper Swivel Car Seat Cover from Ruby Slipper won the Bronze Award. The awards, sponsored by HomeCare Magazine, are based on attendee votes. Medtrade West took place this week, July 12-14. 

NCPA goes on record on PBM games 

ALEXANDRIA, Va. – The National Community Pharmacists Association, as part of a congressional hearing on Tuesday, submitted a statement on the record pushing the Senate Judiciary Subcommittee on Competition Policy, Antitrust and Consumer Rights to scrutinize the role of vertically integrated for-profit companies that have affiliated with pharmacy benefit managers. “The ability of PBMs to game the system not only results in the closure of pharmacies in rural and underserved communities but increased costs for the patient at the point of sale,” wrote the NCPA in its statement to Sen. Amy Klobuchar, D-Minn., chair of the subcommittee. In its statement, the NCPA specifically recommended that U.S. agencies with enforcement authority increase their focus on anti-competitive transactions involving vertical consolidation of health care organizations, rather than almost exclusively on horizontal theories of harm, and provide additional oversight of pharmaceutical formularies and the “rebate wall” games that can wreak havoc on costs for patients and incentivize PBMs to select higher-priced drugs for their formulary. Senators who spoke at the hearing on their concerns with PBMs were Sens. Chuck Grassley, R-Iowa, Josh Hawley, R-Mo., and Marsha Blackburn, R-Tenn., according to the association. 

sovaSage, Breathe partner 

PITTSBURGH – A new partnership incorporates sovaSage’s TherapistAssist Sleep Assessment & Mask Fitting tool with Breathe’s Diagnostics Home Sleep Test service. This new capability is available for providers using sovaSage TherapistAssist, increasing their efficiencies and improving the care they provide, the two companies say. “Our partnership with Breathe promises to revolutionize how patients are managed in the future,” said William Kaigler, co-founder and CEO of sovaSage, based here. “We are so excited to be working with such a great partner.” The new capability also documents the mask fitting required for the physician’s clinical consultation with the patient, according to the two companies. “We see the sovaSage Therapist Assist tool as a great way to further enhance the value of our service to our partner DMEs, our patients and their physicians,” said Amber Watt, CEO of Breathe, based in Overland Park, Kan. 

Jury convicts DME owners in brace scheme 

DALLAS – A federal jury has convicted Dallas area owners and operators of two DME companies of one count of conspiracy to defraud the United States and to pay and receive health care kickbacks, and one count of conspiracy to commit money laundering. According to evidence presented at trial, Leah Hagan and Michael Hagen, the owners and operators of Metro DME Supply and Ortho Pain Solutions, paid a fixed rate per DME item in exchange for prescriptions and paperwork completed by telemedicine doctors that were used to submit false claims to Medicare. They paid illegal bribes and kickbacks and wired money to their co-conspirator’s call center in the Philippines that provided signed doctor’s orders for orthotic braces. Through the scheme, the Hagens billed Medicare Parts B and C about $59 million and were paid about $27 million. At sentencing, the Hagens each face a max sentence of 25 years in prison. The case was investigated by the U.S. Department of Health and Human Services, the Office of Inspector General and the FBI, and was brought as part of Operation Brace Yourself. 

Numotion earns honor for inclusion 

BRENTWOOD, Tenn. - Numotion has been named a "Best Place to Work for Disability Inclusion" after earning a score of 100 on the 2021 Disability Equality Index (DEI). DEI, a joint initiative of the American Association of People with Disabilities (AAPD) and Disability:IN, is a disability inclusion assessment tool that allows businesses to self-report their disability practices and policies. “Disability awareness is a core part of Numotion’s values and culture of inclusion,” said Mike Swinford, Numotion CEO. “The best way to attract, retain and grow talent with disabilities is to create an accessible and inclusive workplace. The DEI provides the necessary tools toward evaluating our ongoing disability initiatives, while also keeping us up-to-date of changes and recommendations that can enhance our efforts.” The DEI takes about 40 hours to complete online each year. It is modeled off the Corporate Equality Index that highlights LGBTQ-inclusive workplace policies. Now in its seventh year, the DEI exists to help businesses make a positive impact on the unemployment/underemployment of people with disabilities. 

Mon Health, DASCO enter joint venture 

MORGANTOWN, West Va. – Mon Health Equipment and Supplies and DASCO Home Medical Equipment have entered into a joint venture to build a stronger company that better serves communities across north central West Virginia. “This joint venture will allow us to make the most of DASCO’s long-time expertise in the business and ensure Mon Health Equipment and Supplies in Weston and Morgantown remain a vibrant and committed community medical service as it has been for many years,” said David Goldberg, president and CEO of Mon Health System. “Our Mon Health Equipment and Supplies has a rich history of serving the communities and have the best people. Together with DASCO, we will continue that legacy and have an even stronger foundation moving forward, capitalizing on our respective strengths.” The companies together will be known as Mon Health – DASCO Home Medical Equipment and will specializes in respiratory equipment like home oxygen, non-invasive ventilation and CPAP therapy. It will also provide walkers, wheelchairs, adjustable beds, bedside commodes, orthopedic supplies and other DME. Mon Health System is an integrated network of physician clinics, outpatient centers and four hospitals in north central West Virginia. 

Quipt announces proceeds of $17.5M 

CINCINNATI – Quipt Home Medical has announced that, as a result of the exercise of common share purchase warrants at CAD$6.40 per share, originally issued in June 2020, the company has issued an aggregate of 3,389,825 common shares in consideration for $17.5 million. “We believe that the warrant exercises are indicative of overwhelming support from our shareholders for the future of Quipt and our vision for growing into a national DME provider focused on superior patient care,” said Greg Crawford, chairman and CEO. “We have the strongest balance sheet in the history of our company and look forward to executing on our robust acquisition plans for the remainder of the year.” All common shares, other than 960,000, have been issued since April 1, 20201. The company now has about 33,102,529 shares issued and outstanding. 

NCART, NRRTS announce virtual fly-in 

WASHINGTON – NCART and NRRTS will host a Virtual CRT Congressional Fly-in on Sept. 21 from 9 a.m. to 5 p.m. as part of National CRT Awareness Week. “Every year we hold a CRT-focused Washington, D.C., event that keeps CRT advocates connected with Capitol Hill to talk about issues impacting access for people with disabilities,” NCART stated in an announcement. “We’re excited to offer the opportunity to deliver these important messages without asking attendees to leave the comfort of their home or office.” NCART and NRRTS ask stakeholders to save the date, with more details to come soon. 


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