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In brief: Omnibus bill, Performant contract, Cardinal CFO

In brief: Omnibus bill, Performant contract, Cardinal CFO

WASHINGTON – Lawmakers have passed a $1.7 trillion omnibus legislative package that will keep the government funded through September.

A draft of the bill included two major HME policy priorities: an extension for the 75/25 blended Medicare rate for non-CBA/non-rural suppliers through the end of 2023; and the prevention of across-the-board 4% Medicare cuts for 2023 and 2024 that would have been triggered by the application of provisions in 2010 “PAYGO” budget legislation. 

Provisions from H.R. 6641, which would apply a 90/10 blended rate in former competitive bidding areas, are not part of the 4,155-page bill. 
The bill specifically extends the 75/25 blended rates “through the remainder of the duration of the public health emergency period described as Dec. 31, 2023, whichever is later.” 
The bill also grants a two-year extension for telehealth waivers established during the COVID-19 PHE. 
“This is a major win for the home medical equipment community,” said Tom Ryan, AAHomecare president and CEO. “The relief granted for non-rural/non-CBA suppliers, taken with the 50/50 blended rate in rural areas granted to rural suppliers by CMS in the 2021 DMEPOS Final Rule, will impact bottom lines for a large swath of the industry. Preventing potentially ruinous 4% PAYGO cuts on every single Medicare transaction for HME is obviously very consequential across our industry, as well.” 

  • Read the omnibus bill. 
  • Read a summary of Medicare-related provisions. 

OIG calls out unimplemented recommendations 

WASHINGTON – The Office of Inspector General has published its annual “Top Unimplemented Recommendations: Solutions to Reduce Fraud, Waste and Abuse in HHS Programs” and DME makes more than one appearance. 

This year, the OIG’s recommendations focus on the top 25 unimplemented recommendations that, in its view, would most positively affect HHS programs in terms of cost savings, program effectiveness and efficiency, and public health and safety if implemented. 

Recommendations related to DME include: 

CMS should improve and implement system edit processes for its DME Medicare contractors to prevent improper payments for services provided to hospice beneficiaries. 

For 121 of 200 sampled durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items, Medicare improperly paid suppliers for DMEPOS items they provided to hospice beneficiaries. These items were provided to palliate or manage the beneficiaries' terminal illnesses and related conditions and, as such, are considered included in the per diem payments that Medicare pays to hospices. These items should have been provided directly by the hospices or under arrangements between the hospices and the suppliers and not separately paid by Medicare. Medicare improperly paid the suppliers because the system edit processes that should have prevented the improper payments were not effective or did not exist. In some of these cases (67), the suppliers inappropriately used a modifier (GW) to indicate that the items were not related to the beneficiaries’ terminal illness or conditions, but our audit found that these items were related. On the basis of our sample results, we estimated that Medicare could have saved $116.9 million in payments during our audit period from January 1, 2015, through April 30, 2019, and beneficiaries could have saved $29.8 million in deductibles and coinsurance that may have been incorrectly collected from them or from someone on their behalf. 

CMS should require MAOs to submit and encourage MAOs to provide program oversight based on an ordering provider’s national provider identifier (NPI) on encounter records for DME, prosthetics, orthotics and supplies, as well as for laboratory, imaging and home health services. 

Ordering and referring provider identifiers are not required in, and were frequently absent from, Medicare Advantage encounter data for records of DME, prosthetics, orthotics, and supplies, clinical laboratory, imaging, and home health services. The lack of ordering and referring provider identifiers limits the use of these data for vital program oversight and enforcement activities. For example, these provider identifiers are critical for identifying questionable billing patterns and pursuing fraud investigations for ordering and referring providers. In an OIG survey conducted in 2020, almost half of the MAOs that lacked ordering NPIs on at least some MA encounter records raised concerns that this hindered their data analysis for program integrity. An NPI is an important tool for assessing whether ordering or referring providers have determined that services were appropriate for patients. 

To read more, go here

Performant renewed for audit contract 

LIVERMORE, Calif. - Performant Healthcare Solutions has announced that CMS has awarded the company the Medicare Secondary Payer (MSP) Recovery Audit contract, also known as the Commercial Repayment Center (CRC), for a six-year term consisting of one base year and five option years. This is a contingency fee contract, meaning CMS pays Performant a percentage of overpayment recoveries returned to the Medicare Trust Fund. “This contract win is an affirmation of our demonstrated history of continuous improvement that has resulted in annually increasing and record setting recoveries to the MSP CRC program,” stated Simeon Kohl, president of Performant. “We are honored to serve CMS as one of our longest health care partners. And we are excited to be recognized by CMS as a best value contractor on multiple, national programs. These programs afford Performant a unique view of the national healthcare landscape and trends.” Performant, which has been the incumbent MSP CRC contractor since September 2017, has increased recoveries to the Medicare Trust Fund by nearly 340% per year through the end of FY 2021. Under the contract, Performant is responsible for identifying and recovering payments in situations where CMS should not be the primary payer of health care claims because a beneficiary has other forms of insurance coverage, such as through an employer Group Health Plan or certain other payers. In addition to the MSP CRC contract, Performant also serves as the CMS Recovery Audit Contractor (RAC) for Regions 1, 2, and the nationwide Region 5 for DMEPOS and Home Health and Hospice (HH&H) claims. Further, Performant was recently selected as the sole national medical reviewer for the Health and Humans Services Office of the Inspector General. 

WellSky, Option Care Health expand partnership 

OVERLAND PARK, Kan. – WellSky has expanded its partnership with Option Care Health Inc. to accelerate innovations and workflow enhancements within WellSky’s infusion and specialty pharmacy platform, CareTend. Option Care will implement the software across its more than 160 locations. “Our decision to select WellSky’s CareTend as our go-forward platform was pivotal to our core value of delivering comprehensive infusion care resulting in greater operating efficiencies and higher patient satisfaction,” said John Rademacher, president and CEO of Option Care Health. "Expanding our partnership with WellSky will help ensure we have the technology needed to improve our pharmacy operations and point of care oversight in either the home or one of our infusion suite operations, allowing us to deliver a cutting-edge care experience for even more patients.” The partnership between WellSky and Option Care Health will allow both organizations to play a critical role in advancing the technologies that drive infusion and specialty pharmacy operations in the pursuit of better outcomes at lower costs, the companies say. “WellSky is thrilled that our technology development efforts will be influenced by one of the largest and most respected providers in the infusion therapy space,” said Bill Miller, CEO, WellSKy. “Our continued collaboration with Option Care Health further strengthens WellSky's ability to deliver software built for more personalized, connected care.” 

MobilityWorks presents mobility vans to three veterans 

TAMPA, Fla. – MobilityWorks and non-profit Help Our Military Heroes presented three veterans with new vans as part of their 200th grant celebration. “Help Our Military Heroes was founded with a very specific mission in mind: to provide wheelchair accessible transportation to wounded, injured and/or ill active-duty service members and veterans who sustained their wounds or injuries while on active duty or in the service,” said Co-founder Ted Hollander. Help Our Military Heroes has awarded 205 vehicle grants since they began their mission. More than 130 of those have taken place through a MobilityWorks location. Territory Manager Scott Shelby has been involved in 22 van presentations alone in Tampa and says it is an honor to help our nation’s veterans maintain their independence. “It’s an honor to serve the heroes of our country, and for us to be able to help them maintain their mobility and freedom that we take for granted – it’s an honor, and humbling at the same time,” he said. 

  • CEO Bryan Everett discusses MobilityWorks’ 25 years in business. 

 Ability Members adds Starkmans 

TORONTO – Ability Members Group has added Starkmans Health Care Depot to its membership. A Toronto institution for more than nine decades, Starkmans began as a pharmacy and grew into a key destination for health care products ranging from ostomy, home safety and mobility aids to rehab and home medical equipment. “Joining Ability Members Group represents an important decision for us,” said Joan Starkman, president of Starkmans. “We made the decision based on the quality of the current members; the opportunity to collaborate meaningfully with both other members and suppliers; and most importantly, the leadership they demonstrate in the market.” Ability Members Group is a national network of seasoned, independent home medical equipment providers that launched in 2017. The Ability Members Group leverages their collective buying power and supports members to successfully grow their businesses and provide excellence in client care. The network operates locations across Canada. 

Protez Foundation, OneStep partner on remote care platform for Ukrainian amputees 

NEW YORK and MINNEAPOLIS, Minn. – Protez Foundation, a non-profit helping Ukrainian children, soldiers and civilians get free quality prosthetics in the U.S., has partnered with OneStep, an innovative platform for digital physical therapy that turns a smartphone into a clinical-grade motion analysis lab, to provide remote care for patients. “For months, we have been doing prosthetic operations, fittings and treatment plans and then sending patients home with no way to track their progress to determine if and how their treatment plans should be adjusted,” said Yakov Gradinar, certified prosthetist and orthotist and chief medical director, Protez Foundation. “The partnership with OneStep is a game changer – it rounds out our efforts, enabling us to easily stay connected with our patients and get a 360-degree view of their movement from thousands of miles away.” With OneStep’s app, when a person takes a walk with their smartphone in their pocket, even a 30-second walk (no wearables or equipment needed), the app collects a set of gait measurements. This allows for consistent remote monitoring in a patient’s natural environment and the ability to track multiple changes in motion over time. To learn more or to donate to Prosthetics for Ukrainians, please visit: 

AvaCare Medical offers hope 

NEWARK, N.J. - AvaCare Medical is partnering with St. James Social Services Corporation to distribute personal care packages to Newark locals in need. Team members from both organizations will be on-site distributing hundreds of “packages of hope” on Dec. 22 at SJSSC. Locals can also enjoy a hot lunch at Soulfood Café, SJSSC’s soup kitchen, which feeds more than 175 people each day. AvaCare is an online store that provides private-paying customers, as well as medical facilities, with medical supplies and equipment, such as wheelchairs, gloves, incontinence products and more. It is based in New Jersey, but it serves customers throughout the United States. 

Cardinal Health names new CFO 

DUBLIN, Ohio – Cardinal Health and its board of directors have announced that Aaron Alt will become the company’s new CFO, succeeding interim CFO Trish English. Alt will report to CEO Jason Hollar as a member of Cardinal Health’s Executive Committee effective Feb. 10. "We're pleased to welcome Aaron as the new CFO of Cardinal Health," Hollar said. "He's an exceptional talent with a breadth of experience across complex organizations that will position him well for this critical company-wide role. I'd also like to thank Trish for her contributions as interim CFO and her commitment to help with this transition." Alt will lead financial activities across the company, including financial strategy, capital deployment, treasury, tax, investor relations, accounting and reporting. Most recently, he served as executive vice president and CFO for Sysco, a global food service distribution company. In that role, he drove significant improvements to the balance sheet and underlying profitability of the company. 

Woman charged in $17.3M brace and CGM scheme 

NEW YORK – Alexandra Stchaslivteseva, 52, of New York has been arrested for allegedly offering and paying illegal health care kickbacks and money laundering, resulting in Medicare paying more than $17.3 million in false claims. She allegedly offered and paid kickbacks and bribes to several purported telemedicine companies and marketing companies in exchange for completed doctor orders of medically unnecessary orthotic braces and continuous glucose monitors for Medicare beneficiaries. Stchastlivtseva and her co-conspirators allegedly concealed the fraud by entering into sham contracts and producing false invoices characterizing the kickbacks and bribes as payments for “marketing.” She is charged in an indictment filed in the District of New Jersey with conspiracy to defraud the United States and to offer and pay health care kickbacks, five counts of offering and paying health care kickbacks, and conspiracy to commit money laundering.  If convicted, Stchastlivtseva faces a maximum penalty of five years in prison on the count of conspiracy to defraud the United States and offer and pay health care kickbacks, ten years in prison on each count of offering and paying health care kickbacks, and ten years in prison on the count of money laundering conspiracy. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors. 

ProSomnus oral appliance cleared for Medicare reimbursement 

SAN FRANCISCO – ProSomnus, Inc., which makes precision oral appliance therapy (OAT) devices for the treatment of obstructive sleep apnea (OSA), has announced that its ProSomnus EVO {PH] Sleep and Snore Device now qualifies for Medicare reimbursement. The Pricing, Data Analysis, and Coding (PDAC) contractor has reviewed and verified the device for HCPCS code E0486. “With Medicare coding verification, the ProSomnus EVO [PH] offers health care providers and their Medicare beneficiary patients a comfortable, effective and reimbursable treatment option for OSA that addresses many of the limitations of dental product and CPAP therapies,” said Len Liptak, co-founder and CEO of ProSomnus. “Achieving Medicare coding verification for the ProSomnus EVO [PH] enhances our momentum as we expand availability of precision OAT to even more patients, thereby increasing adoption and creating better patient outcomes when treating OSA, a disease state impacting 74 million Americans today.” The ProSomnus EVO [PH] is a precision OAT medical device specifically engineered to meet CMS coding guidelines, offering Medicare beneficiaries a non-invasive, comfortable, easy-to-use and effective alternative to CPAP machines, surgical procedures, and legacy dental products, the company says. Per Medicare coding guidelines, the device repositions and stabilizes the patient’s jaw during sleep, increasing pharyngeal space and reducing the risk of upper airway collapse.  

Tomorrow Health hires VP of talent management 

NEW YORK – Tomorrow Health has announced that Heidi Nicoll has joined the company as vice president of talent management. She will oversee talent management, including talent development and acquisition, and her duties will include attracting and hiring diverse top talent to enable Tomorrow Health to drive forward its vision and mission. "I am proud of the strong and diverse leadership team we are building to drive our efforts to transform a broken and archaic health care system from within," said Vijay Kedar, co-Founder and CEO, Tomorrow Health. "Our people are our greatest asset. Heidi joining us with her deep experience in talent acquisition will help enable our growth and development as a company and ensure that we are attracting and retaining the right talent towards our mission to transform home-based care." Most recently, Nicoll was vice president, head of people and culture, at Splice, where she nurtured and scaled the company with an inclusion-centered approach to all aspects of talent strategy, learning and development, and talent acquisition. Before that, she was vice president of talent acquisition at Shutterstock, where she was instrumental in scaling the company from 300 to 1,400 employees globally. 

NCPA promotes Anne Cassity 

ALEXANDRIA, Va. – The National Community Pharmacists Association has announced that Anne Cassity has been promoted to senior vice president of government affairs. She will lead NCPA’s federal and state legislative and regulatory outreach, spearhead political and external affairs, and work closely with the Department of Policy and Pharmacy Affairs to coordinate the association’s robust advocacy efforts. “Community pharmacy has never been more visible among patients, members of the media and policymakers, and that’s in part due to Anne’s efforts,” says NCPA CEO B. Douglas Hoey, pharmacist, MBA. “With her extensive experience and her background with NCPA, she’s a great fit to lead our government affairs department. We’re excited Anne is stepping into this role as we continue growing community pharmacy’s influence and prominence.” Cassity managed NCPA’s congressional affairs department before leaving the association in 2011 to become health care policy adviser to then-Gov. Bobby Jindal of Louisiana. She spent several years as a government relations director for a Medicaid managed care organization in Louisiana before returning to NCPA in September 2018 to serve as vice president of federal and state government affairs. Cassity has also held positions on the staffs of U.S. Reps. Walter Jones, R-N.C., and Bob Riley, R-Ala.


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