Viemed prevails in ALJ appeal, Medicare returns money

AFAYETTE, La. – An Administrative Law Judge has ruled in favor of Viemed Healthcare, overturning all remaining disputed claims for equipment services, related to findings from the Office of Inspector General.  

As a result, Medicare Administrative Contractors returned 100% of the previously remitted funds to Viemed. 

“We are extremely pleased with the judge’s decision in this matter, which reaffirms the high integrity of our clinical protocols and sets the record straight,” said Casey Hoyt, CEO. “In addition to restoring our long-standing reputation as a best-in-class provider and industry leader, the extensive appeals process was important to us in order to ensure that the right patients continue to have timely access to this life saving care.” 

In a May 2021 report, the OIG reviewed the claims of 100 of Viemed’s patients in an audit of non-invasive ventilation in the home. The OIG concluded that 98% of the sampled claims did not comply with Medicare requirements, asserting that the therapy was not necessary for those patients, in direct contradiction to the conclusions of the prescribing providers.  

In May of 2022, Medicare’s Qualified Independent Contractor found that 77% of certain claims for non-invasive ventilation submitted by Viemed Healthcare were, indeed, medically necessary.  

“The available data and research confirm that timely access to non-invasive ventilation in the home improves health outcomes while simultaneously driving down overall healthcare costs,” said Hoyt. “We will urgently communicate these compelling and clarifying results with payors and treating physicians so that more patients nationwide can receive the lifesaving care they need and deserve.” 

• Read what Casey Hoyt had to say about the OIG report.