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In brief: Orthotics fraud, Medicare Advantage data, Kalogon seed 

In brief: Orthotics fraud, Medicare Advantage data, Kalogon seed 

WASHINGTON – The Office of Inspector General says there are still issues related to CMS’s oversight of off-the-shelf braces, including providers that ordered braces for enrollees for whom there was no history of a treating relationship. 

The OIG also found new suppliers located in geographic areas with known Medicare fraud; Medicare paid more than private payers for OTS braces; and suppliers used prohibited solicitation to contact enrollees. 

“These issues continue to put Medicare and its enrollees at risk and demonstrate the need for CMS to strengthen its oversight related to supplier billing requirements, ordering provider requirements, supplier enrollment and monitoring, Medicare allowable amounts for OTS braces, telemarketing to Medicare enrollees, and fraud related to OTS braces,” the OIG stated. “If not addressed, these issues could result in improper payments, potential enrollee harm, and Medicare paying more than non-Medicare payers, such as private insurance companies, for OTS braces.” 

CMS has consistently found that orthotic braces were consistently among the top 20 items of DMEPOS with the highest improper payment rates. 

To reduce the risk of fraud, waste, and abuse related to OTS braces and to protect the health of Medicare enrollees, the OIG recommends that CMS strengthen its oversight of Medicare billing for OTS braces by: 

  • Taking steps to prevent payments for claims for replacement OTS braces billed without required modifiers; 

  • Identifying providers who ordered OTS braces for enrollees with whom they had no treating relationships, and use that information to determine whether to provide additional education to or take administrative or legal action against the ordering providers or associated suppliers; 

  • Analyzing supplier billing patterns to determine whether to conduct additional prepayment or post-payment reviews of suppliers;  

  • Ensuring that Medicare allowable amounts are reasonably comparable with payments made by non-Medicare payers; 

  • Educating suppliers and enrollees on telemarketing practices for OTS braces; and 

  • Using predictive data analysis and information from other federal agencies and from state agencies to identify emerging fraud schemes related to OTS braces and using CMS’s authority to prevent further losses to the Medicare program. 

CMS did not state whether it concurred with the OIG’s recommendations but described its efforts to reduce and prevent improper payments related to OTS braces. 

From calendar years 2014 through 2020, Medicare paid approximately $5.3 billion for orthotic braces. 

Go here to read the full report. 

AAH makes recs on Medicare Advantage 

WASHINGTON – AAHomecare has responded to a CMS request for information on Medicare Advantage data with recommendations to improve transparency in these plans. The association’s recommendations include: 

Require MA plans to publish data that demonstrates they provide sufficient access to care and patient choice, including measures of beneficiary satisfaction and complaints, as well as the number of in-network DME suppliers by product category and geography. 

Require MA plans to publish data regarding their appeal process for prior authorization (PA) decisions, as well as disclosing detailed PA approval/denial statistics by product category. 

Require MA plans to disclose their use of artificial intelligence in PA and claims processing. 

Require MA plans to disclose data on what benefits they cover under Part D that are also covered under Part B. Even though Medicare has determined that continuous glucose monitors (CGMs) are covered as DME under Part B and that MA plans are required to provide CGMs under Part B, many MA plans are covering these devices and related supplies under Part D prescription drug plans. 

“Comprehensive data on beneficiary satisfaction, access to care, authorization processes, denials/approvals, and coverage policies under MA plans benefits patients, caregivers, and healthcare providers,” AAHomecare stated. “This data is also critical to effective oversight and evaluation of these plans by legislators and regulators. AAHomecare will continue to press for measures that increase transparency in the Medicare Advantage space.” To read the comments in full, go here

EnsoData, Parachute Health integrate 

MADISON, Wis. – EnsoData and Parachute Health are partnering to expedite care for newly diagnosed sleep disorders by simplifying the workflow of various care providers. The two companies will collaborate on a seamless handoff from a physician-signed sleep report directly through to DME providers using Parachute Health. “We’re excited to partner with Parachute Health to better serve patients, sleep physicians and DME providers working from a footprint spanning thousands of physicians and major DMEs,” said Justin Mortara, president and CEO of EnsoData. “By partnering together, we’re setting ourselves up to support a high volume of patients immediately, with the ability to truly expand the overall impact we can have on patient lives and sleep medicine.” EnsoData and Parachute Health are actively working with early joint customers and expect the integration to be widely available in 2024. EnsoData has also announced partnerships with Aeroflow Health and with React Health. The company uses aritificial intelligence and machine learning technology to connect sleep disorder diagnosis to therapy. Parachute Health is an e-prescribing platform with a network of more than 3,000 supplier locations and 220,000 e-signing clinicians across more than 66,000 facilities in all 50 states. 

VGM Canada seeks outstanding women 

BURLINGTON, Ontario – VGM Canada is accepting nominations for the Canadian HME Woman of the Year Award through June 28. The award is open to all women who work in the HME or mobility industry in Canada, including suppliers, physiotherapists, occupational therapists and manufacturers. “Now in the third year, we are thrilled to continue recognizing the outstanding women in our industry with this award,” said Dave Davies, president, VGM Canada. “We hope this award not only provides recognition and visibility to the incredible leaders in our industry but helps promote the overall importance of the industry and the customers we serve every day.” Sheila Buck, an occupational therapist and owner of Therapy NOW!, was named the winner of the 2023 Canadian HME Woman of the Year Award, and Cindy Wickens, founding partner for Xperience Home Healthcare, was named the winner of the 2022 inaugural award. This year’s winner will be selected by a committee of HME and mobility professionals and announced on the first day of the Canadian Seating & Mobility Conference (CSMC) on Sept. 10. Nominations can be made online by visiting the VGM Canada website at Nominators are encouraged to provide examples of how the nominee has made significant contributions throughout her career to serve her patients, community, business and the industry. 

AAH gets additional support from Cardinal Health 

WASHINGTON – AAHomecare has announced that Cardinal Health at-Home Solutions has moved to the Legacy corporate partner level at the association, joining five other companies in that top tier. AAHomecare President and CEO Tom Ryan said the company has been an asset on the association’s Medical Supplies Council, Diabetes Council, Breastfeeding Coalition and associated work groups. “I’m gratified by this latest endorsement of our policy priorities and achievements from Cardinal Health at-Home Solutions,” he said. “Forward-thinking companies who support AAHomecare at partnership levels are providing extra resources that help us deliver value to our members.” Cardinal Health at-Home President Rob Schlissberg said the company believes deeply in AAHomecare’s mission. “It’s as simple as this: The industry needs more strong voices advocating for the value of HME, and AAHomecare is at the forefront of these critical efforts that are no doubt shaping the future of home-based care,” he said.  See a list of all of AAHomecare’s corporate partners here

Kalogon raises funding 

MELBOURNE, Fla. – Smart seating startup Kalogon has raised $1.2 million in extended seed funding to expand its line of products. The company will use the funds to bolster R&D and go-to-market following a standout year of product advancements and record sales that included partnerships with mobility device distributors – such as Etac and National Seating & Mobility – and the completion of the AgeTech Collaborative from AARP’s accelerator program. “This funding is validation for the hard work and tangible results driven by our team in the last year,” said Tim Balz, founder and CEO of Kalogon. “With our relentless pursuit of science-backed innovation and an unwavering dedication to the user experience, we are ushering in a new future for seated wellness. The partnerships and product developments we have achieved recently have opened new doors, and this round will help us further expand our offerings and availability in the market.” Sawmill Angels, M7, SeedFundersOrlando, AARP and additional angels participated in the oversubscribed seed extension. Kalogon also recently completed a Phase 1 SBIR contract with the U.S. Air Force and published research in the Journal of Tissue Viability that demonstrated the efficacy of Kalogon’s APM system. Additionally, the company recently announced its first Medicare-approved wheelchair cushion – OrbiterTM Med – increasing its market by 10x and accelerating reimbursement for medical use.   

Three providers partner to offer LIW products 

RICHMOND, British Columbia – HME Home Medical Equipment, HME Home Health and Harding Medical have partnered to expand pediatric product offerings nationwide. As part of the partnership, the three companies will share the exclusive rights to sell LIW Care Technology products across Canada with a dedicated website, “HME Home Health is excited to partner again with HME Home Medical Equipment and Harding Medical,” said Robert Boscacci, CEO and co-founder of HME Home Health. “We’ve collaborated on nationwide accounts, such as the SGP Purchasing Partner Network, and know this venture with LIW Care will continue our record of successful partnerships.” LIW Care offers medical devices such as standing frames that support the rehabilitation of pediatric clients. The HMEKIDS logo combines the core colors of each company – red for HME Home Medical Equipment, green for Harding Medical and orange for HME Home Health – in a nod to the partnership. 


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