ARLINGTON, Va. – Change of plans. The National CRT Leadership and Advocacy Conference has been moved from mid-March to April 21-23.
“Unfortunately, the House was not going to be in session,” said Don Clayback, executive director of NCART, which has offered to cover any charges that early registrants might incur as a result of the date change.
Originally slated for March 10-12, the conference’s focus—persuading lawmakers to back legislation that would create a separate benefit for complex rehab—remains the same.
Though the last session of Congress ended without passing H.R. 942 and S. 948, Clayback hopes to see the bills reintroduced by the end of February, giving attendees a hard ask for their members of Congress during the conference’s Capital Hill day.
“We’re happy to say that everybody continues to be recommitted and we’re encouraged by the support we had last year,” said Clayback. “We’re looking forward to pushing this over the finish line this year.”
The three-day conference will also feature leadership sessions and funding and advocacy sessions and a keynote address by David Miller, founder of Spirit Ranch, a leadership development retreat center, and former CEO of The MED Group.
This year’s conference will again take place at the Hyatt Regency Crystal City in Arlington, Va.
WASHINGTON – The Office of Inspector General (OIG) calls into question claims for power mobility devices (PMDs) without corresponding G-code claims in a new report.
CMS introduced G0372 in 2005 for physicians to establish and document the need for PMDs.
The OIG found that for PMD claims with corresponding G-code claims, Medicare paid the claims in accordance with federal requirements for face-to-face requirements of beneficiaries. It found for claims without corresponding G-code claims, however, that Medicare did not always pay the claims in accordance with federal requirements. Of 100 sample claims, the OIG found 53 claims met the requirements and 47 did not.
On the basis of physician interviews, the agency concluded that many physicians are unfamiliar with the G code and the face-to-face requirements.
The OIG recommends that CMS (1) adjust the 47 sample claims representing overpayments of $115,000 (2) require physicians to use the G code when prescribing PMDs and (3) require Part B contractors to educate physicians on the use of the G code and the face-to-face requirement.
ELYRIA, Ohio – After a six-month search, Invacare has named an exec with turnaround experience as its new president and CEO.
Matthew Monaghan, 47, currently the senior vice president and general manager of the Global Hips division at Zimmer, a manufacturer of orthopedic products and instruments, will take the helm at Invacare on April 1.
“In addition to his medical device background, he has proven turnaround experience, which will be critical to Invacare as it works through its short-term challenges,” stated Dr. C. Martin Harris, interim chairman of Invacare’s board of directors, in a press release.
Monaghan’s employment agreement with Invacare includes a five-year term and an initial base salary of $750,000 per year, according to a Form 8-K filed with the Securities and Exchange Commission.
As the head of Zimmer’s Global Hips division, a $1.3 billion business, Monaghan oversees product development, engineering, clinical studies, quality, regulatory affairs and marketing functions.
Prior to joining Zimmer in 2009, Monaghan logged eight years as an executive at two private equity firms, Texas Pacific Group and Cerberus Capital, where he led operational improvements for portfolio companies. Among his achievements: carving out a global medical device business from Baxter Healthcare, making significant improvements at a U.S. personal insurance business and running a consumer durable good business spun off from Newell-Rubbermaid.
Monaghan also spent 13 years in aerospace manufacturing and engineering at General Electric.
Other components of Monaghan’s agreement with Invacare: participation in the company’s executive incentive bonus plan with an initial, annual bonus target opportunity of 100% of his base salary; participation in the company’s long term incentive plan with an initial, annual equity grant with a value of $1.4 million as of the April 1 grant date; and an additional incentive award of service-based restricted shares with a value of $1 million as of the April 1 grant date, which will vest ratably on an annual basis over three years.
Rob Gudbranson, who has been acting as interim president and CEO since the departure of Gerald Blouch in July, will stay on as senior vice president and chief financial officer. His base salary will be set at $475,000 per year with an additional grant of service-based restricted shares with a value of $375,000 as of the April 1 grant date, according to the Form 8-K. The shares will vest 100% at the end of a three-year period on May 15, 2018.
ORLANDO, Fla. – AeroCare has acquired Plant City, Fla.-based Matrix Medical, a provider of home medical equipment, supplies and respiratory equipment with nine locations throughout Florida.
Terms of the deal were not disclosed.
"We’re looking forward to working with them to pursue opportunities and to care for our patients," AeroCare founder and CEO Steve Griggs said in a local news article.
In late December, a planned merger between AeroCare and MergeWorthRx fell through.
Rotech strikes again
ORLANDO, Fla. –Rotech has made its second acquisition in as many months: the respiratory equipment assets of a company in Natchitoches, La.
The name of the company was not disclosed.
“This purchase is another step in Rotech’s aggressive expansion plan,” stated Tim Pigg, CEO, in a press release. “We will be continuing to further leverage and expand our presence in existing and new markets with the support of our long-term oriented investors.”
In December, Rotech acquired the assets of a specialty medical services provider in Cody, Wyo.
ELYRIA, Ohio – Invacare has secured a new revolving credit and security agreement, establishing a $100 million asset-based lending senior secured credit facility, the company announced Jan. 16.
“Under the new credit facility, the company will not have the financial covenant limitations, such as the debt leverage covenant, which was in the previous credit agreement,” stated Rob Gudbranson, interim president and CEO, and senior vice president and CFO, in a press release. “We appreciate the support of our bank group in negotiating this new facility.”
The new credit facility, which matures January 2018, replaces Invacare’s prior senior secured credit facility, which was set to mature October 2015.
The borrowing availability under the new credit facility is determined by the value of Invacare’s eligible accounts receivable, inventory, and machinery and equipment assets in the United States and Canada, up to a maximum aggregate borrowing amount of $100 million.
Invacare’s preliminary aggregate borrowing base under the new credit facility is about $76 million, which is further limited by a number of provisions.
BOCA RATON, Fla. – An attorney for a mail-order contract supplier that was raided by the FBI last week says the company has “nothing to hide.”
“Med-Care Diabetic & Medical Supplies has always been transparent in cooperating with…inquiries,” said Justin Weddle, an attorney with Brown Rudnick, in an email to HME News. “The company has nothing to hide."
Federal agents on Jan. 14 descended on the company about 9:30 a.m. and sent most of the company’s employees home. Agents were seen removing boxes throughout the day, according to local news reports. Representatives of the local police department, the Florida Division of Insurance Fraud, the Internal Revenue Service and the Department of Homeland Security also participated.
“The process used today was unexpected, but the company is cooperating, and will continue to cooperate, fully,” said Weddle.
Weddle said that in July the company learned that a federal regulatory agency was inquiring about its business practices.
“We contacted them and offered to answer their questions and provide whatever information they needed,” he said.
At press time, neither the FBI nor CMS, which in 2013 awarded the company a national contract for mail-order diabetes testing supplies, had responded to requests for comment.
A seizure is an ‘extreme’ action, say industry attorneys, although it doesn’t point to evidence of guilt.
“A seizure means the government has credible evidence that documentation may be moved or destroyed or somehow tampered with,” said Jeff Baird, chairman of the Health Care Group at Brown & Fortunato.
Med-Care has come under scrutiny before. Med-Care president Dr. Steve Silverman was subpoenaed by Sen. Claire McCaskill, D-Mo., to testify at a 2013 hearing before the Senate Subcommittee on Financial and Contracting Oversight. The company had been the subject of complaints for its marketing practices.
Danny Porush, one of the company’s top executives, was convicted of insider trading and money laundering, among other things, in 2002 and ordered to pay $200 million in restitution. He inspired a character in the movie, “The Wolf of Wall Street.”
Med-Care was founded in 1999. It has 500 employees and serves more than 250,000 patients, according to its website. In 2013, it received nearly $11.2 million in reimbursement from Medicare for blood glucose test strips, according to the HME Databank.
One big question: Could Med-Care’s mail-order contract be at risk as a result of last week’s actions?
Maybe yes, maybe no, says Baird.
“The contract says that Med-Care must adhere to all laws and statutes and regulations including supplier standards,” he said. “The competitive bidding implementation contractor could take steps to terminate the contract. Or, they might sit back and say, ‘innocent until proven guilty.’”
The company could also have its PTAN number revoked, he said.
WASHINGTON – With the bid window for the Round 2 re-compete of competitive bidding set to open this week, industry stakeholders are eyeing their options to fast track a pair of bills to reform the bidding program.
“We want to get this legislation passed quickly,” said Jay Witter, senior vice president of public policy at AAHomecare. “We are hopeful we can get on the suspension calendar.”
Both bills, introduced Jan. 12, would require providers to obtain bid bonds and provide proof of licensure before submitting bids. H.R. 284, introduced by Reps. Patrick Tiberi, R-Ohio, and John Larson, D-Conn., had 27 original cosponsors and has since added four additional cosponsors. S. 148, introduced by Sens. Rob Portman, R-Ohio, and Ben Cardin, D-Md., has four original cosponsors.
“The fact that they dropped on the same day for our cause and that they came out of the chute with cosponsors is, to me, something to tip our hats about and say we made a big difference last year,” said Tom Ryan, president and CEO of AAHomecare.
With the bidding window for the Round 2 re-compete slated to open later this week, stakeholders want to avoid a long, drawn process. The suspension calendar, held every week that Congress is in session, allows lawmakers to consider a number of suspension bills. There is typically five minutes of debate, followed by a voice vote.
“Both bills are equally important, but it’s likely the House bill would move first,” said Witter. “The House is ready to go on this and up-to-date. The likelihood of it passing is very good.”
WASHINGTON – The Office of Inspector General (OIG) says it will use Medicare claims data to review the impact of competitive bidding on beneficiary access to DME, but industry stakeholders don’t want the agency to stop there.
“If our industry is allowed to provide the information that we have been collecting for fair judgment, we are hopeful that the OIG would come to the same conclusion that the bid program has negative impacts on beneficiaries,” said Kelly Turner, director of advocacy for People for Quality Care, which has collected thousands of beneficiary complaints through a national hotline.
But the industry doesn’t have the best track record with government investigations.
A report on the Round 1 rebid of competitive bidding conducted in 2014 by the Government Accountability Office (GAO), for example, simply “parroted” CMS, stakeholders charged. It found that the number of beneficiaries decreased by about 22% in bid areas vs. 16% in non-bid areas due to overutilization, not a decrease in access.
“We hope they will look at what is actually happening to utilization,” said John Gallagher, vice president of government relations for The VGM Group. “Not utilization dropped, ergo it must have been fraud. Rather that utilization dropped because patients did not get what they needed.”
Lisa Wells, who works on Save My Medical Supplies, AAHomecare’s consumer campaign, says this is also a story that goes beyond data.
“By working directly with Medicare beneficiaries, our industry knows that quality of care is not just a numbers game,” said Wells, president of Get Social Consulting. “It also comes down to ease of access to care and the right kind of care that keeps patients informed, engaged and independent.”
The industry does have this in its favor: The number of reports on competitive bidding is piling up, hopefully catching the eyes of lawmakers. This OIG study will be the agency’s fifth on the program.
“The OIG turning its attention to the issues surrounding competitive bidding is a big deal because it helps lend credibility to our claims and will definitely help our efforts on the Hill,” said Anna McDevitt, who also works on Save My Medical Supplies and is the president of Laboratory Marketing. “It’s no panacea but it’s undeniable progress.”
YARMOUTH, Maine – Imagine having a claim denied because Medicare doesn’t like the handwriting on the prescription.
That was the case for one provider who responded to a recent HME NewsPoll on audits, who was told the handwriting on the prescription didn’t match the doctor’s signature, and therefore it wasn’t valid.
“Medicare told us the medical prescription was written by a girl—‘we can tell,’” said the provider. “Since when did Medicare become a handwriting expert?”
The majority (72%) of respondents say they were audited more frequently in 2014 than 2013; 18% said they were audited less and 10% reported no change.
To that end, 72% of providers have dedicated more resources to deal with the onslaught of audits; 16% of respondents reported that they haven’t.
Respondents were also asked to share the most ridiculous reason they were denied.
Many reasons were due to a mistake on Medicare’s part. For example, one provider said, the agency had a beneficiary listed as dead, then alive, then dead again, while others challenged common sense.
Several providers reported receiving denials for wheelchairs for paraplegics and amputees, including one provider who said a power wheelchair for a paraplegic was denied because he also owned a truck.
“But I don’t believe his truck would fit in his apartment,” said the provider.
A number of respondents expressed frustration about denials because contractors overlooked information.
“A RAC audit stated the patient's weight was missing when it was there in three different places,” said Craig Rae, owner of Salisbury, N.C.-based Penrod Medical Equipment.
Also contributing to frustration: contractors not adhering to Medicare rules. One provider reported receiving a denial because the doctor didn’t include his credentials and the date next to his signature on the chart notes, even though the Medicare Program Integrity Manual said it was not required.
As one provider put it, “Our favorite denials are the denials that aren't actually denials, but where the person auditing the information does not know Medicare policy and denies the claim in error.”
WASHINGTON – Performant Recovery has filed a Government Accountability Office (GAO) bid protest against CMS. The protest, filed Jan. 6, comes on the heels of the agency’s announcement that it had selected Connolly as the recovery audit contractor (RAC) to oversee the national program for DME, home health and hospice. Wilton, Conn.-based Connolly is the current RAC for Jurisdiction C, while Performant Recovery in Livermore, Calif., is the contractor for Jurisdiction A. The national program is on hold until the GAO announces its decision on the protest, which it must make by April 16. Until a decision is made, the four current RACs will continue auditing DME claims in their respective jurisdictions.
Have questions? PFQC will get them answered
WATERLOO, Iowa – People for Quality Care (PFQC), an advocacy group and division of The VGM Group, has launched a Q&A series to address questions about home care and HME.
PFQC encourages users to post questions on Twitter using the hashtag #PFQCQNA. The group will take the questions it receives and set out to get them answered. The first question in the series: Is homecare reform a priority for Congress? So far, the question has received responses from Sens. Mike Enzi, R-Wyo., and John Thune, R-S.D., and Reps. Diane Black, R-Tenn., and Tom Price, R-Ga. The second question will address issues that Medicare beneficiaries are experiencing with wheelchair repairs. “We want readers and stakeholders to really drive this series,” said Lalaina Rabary, communications and marketing specialist for PFQC.
Medicare official resigns
WASHINGTON –CMS Administrator Marilyn Tavenner, announced she will be stepping down from her post next month in an email to CMS staff. “It is with sadness and mixed emotions that I write to tell you that February will be my last month serving as the administrator for CMS,” she wrote. During her five-year tenure at the agency, Tavenner oversaw the rollout of the Affordable Care Act (ACA) and the expansion of Medicaid.
M&A activity: Midwest Respiratory and Prism Medical
OMAHA, Neb. – Midwest Respiratory & Rehab has acquired Community HME, a diversified HME provider with locations in Baraboo and Richland Center, Wis. The deal allows Midwest Respiratory, which has 10 locations in Nebraska, Iowa, Missouri and South Dakota, to crack the Wisconsin market. “The acquisition of Community HME has further expanded our regional capability to provide exceptional service to our patients and referral sources,” stated President Edward Delashmutt in a press release. “We have been constantly dedicated to serving rural communities with the same high standard of care that our metropolitan customers have come to expect.” Community HME will retain its name and continue to operate its locations.
Prism bulks up on accessibility
TORONTO – Prism Medical has announced that its wholly owned subsidiary Angel Accessibility has acquired substantially all of the assets and business of Angel Accessibility Solutions, a British Columbia-based provider of safe patient handling and elevating products and services. Angel Accessibility paid $3.675 million for Angel Accessibility Solutions, according to a press release. As part of the deal, Prism acquired the exclusive rights to distribute and service bathing, transfer and transport devices and hygiene products on behalf of Beka-Hospitec in Canada, except for Quebec and the Atlantic Provinces.
Healthcare technology company meets managed care
MINNEAPOLIS and HARTFORD, Conn. – Minneapolis-based Ability Network and Hartford, Conn.-based CareCentrix have partnered to enhance communication during as patients transition from the hospital to the home. “Ability and CareCentrix share a common vision: improving the healthcare experience in this country,” said Mark Briggs, Ability CEO, in a release. The two companies will integrate their software systems to automatically inform discharge planners when a patient’s DME and home infusion therapy needs to be managed by CareCentrix.
Last week on Access Health: Guests from Hollister
LIBERTYVILLE, Ill. – Guests from Hollister were featured on the Jan. 14 episode of Access Health, a health and wellness series on Lifetime, to discuss catheters. Dale Spencer, a spinal cord injured author/speaker and consultant for Hollister, and Mary Wisner, a clinical education manager at the company, planned to speak with host Ereka Vetrini and medical expert Dr. Dennis Holmes about the different types of intermittent catheters available, and who may need to use catheters and why. Dale will also share his personal story. The episode will also be viewable at www.accesshealth.tv.
Socks for sleep?
NEW YORK – Wearing compression stockings during the day may slightly improve sleep apnea at night, according to a Reuters Health story on a new small study. In the study, 22 patients with obstructive sleep apnea who wore compression stockings during the day for two weeks saw their frequency of apneas decrease by 27% compared to 23 patients who didn’t wear the stockings, Dr. T. Douglas Bradley and colleagues have reported in Sleep Medicine. Bradley and his colleagues say the socks reduced sleep apnea in patients from the severe to moderate range. They believe fluid can move from the legs into the neck, restricting the flow of oxygen and causing obstructive sleep apnea. “Getting rid of excess fluid is one approach of treating sleep apnea,” Bradley told Reuters Health.
ResMed shares near 52-week high
SAN DIEGO – ResMed shares were recently traded at $59.83, falling just short of the stock’s 52-week high of $60.16. Volume was also up: 1,778,001 shares, compared to the average volume for the last 30 days: 942,838.
People and places: Pride Mobility, 101 Mobility, Drive Medical
Pride Mobilityhas named Randy Walsh vice president of Jazzy and Retail Mobility Sales. An industry veteran, Walsh has a decade of experience in the retail mobility industry…101 Mobilityof Little Rock, Ark., has appointed Phillip Jacuzzi as its new sales and service manager. Jacuzzi comes to 101 Mobility with 15 years of experience in the bus transportation industry…Drive Medical will exhibit its range of wheelchairs, bathing aids and pediatric equipment at Arab Health 2015. The manufacturer will showcase, specifically, its Expedition Plus Wheelchair, part of its range of travel wheelchairs. It’s the seventh year that Drive has exhibited at the event, which takes place Jan. 26-29 at the Dubai International Convention & Exhibition Centre.
WASHINGTON – Performant Recovery has filed a Government Accountability Office (GAO) bid protest against CMS.
The protest, filed Jan. 6, comes on the heels of the agency’s announcement that it had selected Connolly as the recovery audit contractor (RAC) to oversee the national program for DME, home health and hospice.
Wilton, Conn.-based Connolly is the current RAC for Jurisdiction C, while Performant Recovery in Livermore, Calif., is the contractor for Jurisdiction A.
The national program is on hold until the GAO announces its decision on the protest, which it must make by April 16. Until a decision is made, the four current RACs will continue auditing DME claims in their respective jurisdictions.
BOCA RATON, Fla. – The FBI raided the offices of Med-Care Diabetic and Medical Supplies Wednesday morning.
Representatives of the local police department, the Florida Division of Insurance Fraud, the Internal Revenue Service and the Department of Homeland Security also participated, according to a local news report. Employees were sent home.
It’s not the first time the company has come under scrutiny. Med-Care president Dr. Steve Silverman was one of two HME providers subpoenaed by Sen. Claire McCaskill, D-Mo., to testify at a 2013 hearing before the Senate Subcommittee on Financial and Contracting Oversight. The company had been the subject of complaints for its marketing practices.
At the hearing, Silverman said: “We are regulated, we are inspected, and whatever rules and regulations there are, I give it my best effort for myself and all my employees for us to follow this. I want to play by the rules.”
Med-Care holds a national Medicare mail-order contract for diabetes testing supplies. In 2013, the company received nearly $11.2 million in reimbursement from Medicare for the supplies, according to the HME Databank.
WATERLOO, Iowa – People for Quality Care (PFQC), an advocacy group and division of The VGM Group, has launched a Q&A series to address questions about home care and HME.
“The series was created in response to the many questions medical equipment users and HME groups have asked us,” said Kelly Turner, director of advocacy for PFQC, in a press release.
PFQC encourages users to post questions on twitter using the hashtag #PFQCQNA. The group will take the questions it receives and set out to get them answered.
The first question in the series: Is homecare reform a priority for Congress? So far, the question has received responses from Sens. Mike Enzi, R-Wyo., and John Thune, R-S.D., and Reps. Diane Black, R-Tenn., and Tom Price, R-Ga.
The next question in the series will address issues that Medicare beneficiaries are experiencing with wheelchair repairs.
“We want readers and stakeholders to really drive this series,” said Lalaina Rabary, communications and marketing specialist for PFQC.
OMAHA, Neb. – Midwest Respiratory & Rehab has acquired Community HME, a diversified HME provider with locations in Baraboo and Richland Center, Wis.
The deal allows Midwest Respiratory, which has 10 locations in Nebraska, Iowa, Missouri and South Dakota, to crack the Wisconsin market.
“The acquisition of Community HME has further expanded our regional capability to provide exceptional service to our patients and referral sources,” stated President Edward Delashmutt in a press release. “We have been constantly dedicated to serving rural communities with the same high standard of care that our metropolitan customers have come to expect.”
Community HME will retain its name and continue to operate its locations.
Prism bulks up on accessibility
TORONTO – Prism Medical has announced that its wholly owned subsidiary Angel Accessibility has acquired substantially all of the assets and business of Angel Accessibility Solutions, a British Columbia-based provider of safe patient handling and elevating products and services.
Angel Accessibility paid $3.675 million for Angel Accessibility Solutions, according to a press release.
As part of the deal, Prism acquired the exclusive rights to distribute and service bathing, transfer and transport devices and hygiene products on behalf of Beka-Hospitec in Canada, except for Quebec and the Atlantic Provinces.
Prism expects the deal to be accretive to its earnings for the financial year ending Nov. 30.