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Rx and Specialty Providers hme news / june 2016 / www.hmenews.com 17 WHITe plAINS, N.y. – Byram Healthcare has agreed to pay $9.3 million to settle allega- tions that it was involved in a kickback scheme to increase sales. Byram was the subject of a whistle- blower lawsuit fled by two former and one current employee of Coloplast, alleg- ing it had violated the False Claims Act. The settlement with Byram resolves allegations that, in 2012 and 2013, it received numerous kickbacks from four manufacturers of ostomy and continence care products—Coloplast, Hollister, Montreal Ostomy and Safe N' Simple—in return for its agreement to conduct pro- motional campaigns and to refer patients to the products of these manufacturers. It also resolves allegations by the fed- eral and California state governments that Byram submitted infated claims to the Medi-Cal program in violation of state regulations that limit the amount a pro- vider can bill for certain products. "There is no fnding of liability," stated Perry Bernocchi, CEO. "We are pleased to have put this matter behind us. We look forward to continuing to serve our customers by delivering high-quality supplies and services prescribed by their healthcare professional, supporting their treatment and improving their health and quality of life." Hollister, which was also a defendant in the lawsuit, also settled in May, for $11.4 million. Other defendants in the lawsuit include 180 Medical, A-Med Health Care Cen- ter, CCS Medical, RGH Enterprises d/b/a Edgepark Medical Supplies, and Shield California Health Care Center. Claims against two other defendants, Coloplast and Liberator Medical Sup- ply, were resolved in December 2015 for almost $3.7 million. hme Byram agrees to settle kickback allegations on my initial preparatory prosthetic," said the 40-year-old from Portland, Ore. "Then, when I advanced to being ready for a defnitive prosthetic, I was met with wave after wave of denials. Many, many months passed that I could have been advancing my recovery." After a public uproar, CMS said it would hold off on implementing the LCDs until further study, but the sim- ple fact that the agency didn't withdraw them made the proposed changes fair game for other payers, says AOPA. Adding to stakeholder frustration: everything from the lack of transpar- ency from the very start of the LCD process, to CMS's refusal to name the individuals who comprise a workgroup it has formed to study the changes. "There is no assurance that any stake- holders or patients would be involved in this," said Tom Fise, executive director of AOPA. CMS has also denied a Freedom of Information Act request fled by AOPA asking to view the several thousand public comments made on the pro- posed rule. There are currently about 2 million amputees in America, and that number is growing by nearly 200,000 a year. Appropriate prosthetic devices enable most of them to return to their previ- ous activity level and lifestyle, they say. "Under United's coverage, I would not be able to have the same device as I currently use to keep my lifestyle as active," said Rob Rieckenberg, 37, of Minneapolis, who lost a leg after he was mugged and left on train tracks and was hit by a train. "It's hard enough to recover from losing a limb, but to be told by your insurance company that it's not a medical necessity is another devastating blow." hme are a critical window." In all, 71 participants from 21 states and the District of Columbia had 214 scheduled meetings with members of Congress. LAG is an all-volunteer organization made up of patients, caregivers, healthcare professional, and HME providers and manufacturers. The Lymphedema Treatment Act would require Medicare to pay for compression garments, bandages and supplies to reduce lymphedema-related swelling and prevent its recurrence. Currently, Medicare pays for pneumatic compression pumps, as well as therapy provided by a PT/OT. That's a little short sighted, say advocates. "Even if a patient is granted a pump, they have to use compression between pump ses- sions with that compression being the gar- ments that you can actually wear 23 hours a day," said Heather Ferguson, founder and executive director of LAG. "Otherwise, all that fuid re-accumulates." The legislation, introduced in the Senate in December 2015 and in the House of Rep- resentatives in March 2015, has 16 and 220 co-sponsors, respectively. As is often the case, despite widespread prOSTHeTIcS C O n t i n u e d F R O m p R e v i O u s pa g e defnitions for chronic respiratory failure, as well as for mechanical ventilators/ven- tilation, and to create objective, consistent criteria for providing the products. Having greater clarity on what Medicare believes is the appropriate device would solve a lot of problems, say stakeholders. "When the coverage criteria is not clear it's very diffcult for providers to make a judgment call on if they are going to get paid or not," said Chris Salmen, senior manager of market access for ResMed and a member of AAHomecare's ventilator work group. "When the clinicians are saying it's the right device but Medicare is saying it's not the right device, they get stuck in the middle and so do the patients." CMS has until the end of May to respond to the groups' request. Revising an NCD isn't something that happens often, say stakeholders "CMS is reviewing the reconsideration request," said Andrea Stark, a reimburse- ment consultant with MiraVista. "I think CMS recognizes that there are still some gray areas." hme veNTIlATOrS C O n t i n u e d F R O m p R e v i O u s pa g e support on the Hill, there is occasional push- back about cost, says Bruce Carroll, direc- tor, health policy & reimbursement strategy for BSN, which manufactures products for wound care and related vascular diseases. "It's a logical step that (lawmakers) understand that covering these garments would prevent things like hospitalizations or amputation," he said. "They understand once you present it to them. The upfront cost is relatively low." If Medicare will pay for coverage, it's a good bet that private insurers will follow suit, say advocates. "I do think that HME providers are seeing a lot of patients that don't have cov- erage for compression and so either they have to scrape together nickels and dimes to pay for the garments or they don't use them and then they rely solely on the pump, which is effective but only for a short amount of time," said Christa Miehe, president of Essen- tially Women, a member services organiza- tion owned by The VGM Group. "There are a lot of people who would be better served health-wise and there are people that don't have $400 or $500 to pay out of pocket." hme lympHedemA C O n t i n u e d F R O m p R e v i O u s pa g e Christa Miehe Group surveys drivers on sleep apnea ArlINGTON, va. – The American Transpor- tation Research Institute has launched an online survey seeking input from commercial drivers on a number of is- sues related to sleep apnea. ATRI is surveying drivers on their perspectives, personal experiences and knowledge of sleep apnea. It also seeks information on the sleep apnea assessments and treat- ments that drivers may have received, as well as the perceived effectiveness of those treatments. The survey results will be synthesized with other sleep apnea and driver fatigue research analyses, and then analyzed by several leading sleep apnea experts.