HME News

JUN 2019

HME News is the monthly business newspaper for home medical equipment providers. This controlled circulation publication reaches 17,100 home medical equipment services providers, including traditional HME dealers & suppliers, hospital- and pharmacy-o

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T H E B U S I N E S S N E W S P A P E R F O R H O M E M E D I C A L E Q U I P M E N T P R O V I D E R S HME NEWS POLL ■ Brightree CEO Matt Mellot talks about what's next for the software company. See page 20. ■ Product Spotlight: Check out the hottest offerings in home oxygen therapy, including the Invacare HomeFill. See page 19. ■ Have any MCOs left your state Medicaid program? See results on page 22. Stakeholders call out 'obvious' fraud ResMed pilots blended model MS SUPPLY TAKES ON WELLCARE N E W S ■ AAHomecare readies 'aggressive' agenda. PAGE 3 ■ Newspoll: Pay attention to bid calculators. PAGE 3 D E PA RT M E N T S PROVIDERS ■ Bill breathes life into telehealth. PAGE 13 ■ Q&A: Craig Rae raises profi le of HME at NSBA. PAGE 13 MOBILITY ■ Accessories bills back in play. PAGE 15 ■ Q&A: Mike Osborn, Simon Margolis Fellow. PAGE 15 RX & SPECIALTY PROVIDERS ■ O&P stakeholders take steps to preserve access. PAGE 17 ■ New PHS CEO inspired by patients. PAGE 17 VENDORS ■ PECO Medical drops out. PAGE 20 ■ Supreme Medical levels playing fi eld. PAGE 20 W W W . H M E N E W S . C O M 'It's a clear kickback, black and white,' says healthcare attorney Jeff Baird VOLUME 25 — NUMBER 6 JUNE 2019 $7.00 POC WATCH O P E R AT I O N B R A C E Y O U R S E L F S E E PA G E 1 8 COMMENTARY ■ The ultimate goal is federal legislation to protect complex rehab as a separate benefi t, but we'll take the state wins, too, says Bill Mixon, CEO of NSM. PAGE 8 Separate benefi t: Bill 2.0 makes debut in House R E S M E D P O C S E E PA G E 2 1 BY LIZ BEAULIEU, Editor WASHINGTON – HME industry stake- holders aren't surprised by a $1.2 billion fraud scheme involving medically unnecessary braces and they're glad to see "bad actors" punished. The feds in April charged 24 defendants with an alleged BY THERESA FLAHERTY, Managing Editor M S SUPPLY and Home H e a l t h C o m p a n y, a mom-and-pop provider, has fi led a lawsuit against Well- Care, claiming the managed care organization owes it more than $1 million. BY LIZ BEAULIEU, Editor WASHINGTON – An updated bill to create a separate benefi t within Medicare for complex rehab technol- ogy—a long-time goal of stakeholders—has been introduced in the House of Representatives. Reps. Jim Sensenbrenner, R-Wis., along with Brian Hig- gins, D-N.Y., introduced H.R. 2408, a bill that would allow for targeted coverage and payment policies for CRT, on April 30, the day before the National CRT Leadership and Advocacy Con- ference in Washington, D.C. "People ask, 'What do we need to do to get these bills passed and get them done with,' and my quick answer is, 'We need more,'" said Don Clayback, executive director of NCART during his opening address at the conference. "We BY LIZ BEAULIEU, Editor SAN DIEGO – ResMed in late March quietly launched a pilot program, Oxyensure, to sell portable oxygen con- centrators by the same name directly to cash customers and through providers to insurance customers. Oxyensure, and its accom- panying website, www.oxyen-, uses a similar busi- ness model to one launched by Invacare and Philips last year. "Oxyensure is a ResMed pilot program connecting patients who are searching for scheme involv- ing illegal kick- backs and bribes by DME compa- nies in exchange for referrals of Medicare ben- e f i c i a r i e s b y medical profes- sionals work- ing with fraudulent telemedicine companies for back, shoulder, wrist and knee braces. "Stakeholders have been warn- ing that this is a bad thing and not to do it," said Jeff Baird, chair- man of the Health Care Group at Brown & Fortunato. "There's no gray area here. The DME pays a lead generation company, the lead generation company pays a tele- medicine company, and the tele- medicine company pays a doctor who writes the order that goes back to the DME. It's a clear kick- back, black and white." In late March, before the indict- ments, the American Orthotic & Prosthetic Association even MS Supply contracted with WellCare to provide DME, com- plex rehab and home health services to Medicare Advantage patients throughout the state of Florida in 2015, and has received approximately 15 home health referrals and 25 to 30 DME refer- rals from them a day. Problems didn't start until 2016, says Farie Sanchez, COO. "We started noticing glitch- es," she said. "We'd send emails saying, 'Hey, you underpaid us, what's going on?'" In addition to underpayments, MS Supply has had money M S S U P P LY S U E S S E E PA G E 1 4 S E PA R AT E B E N E F I T S E E PA G E 1 6 Jeff Baird THE OXYENSURE POC is ResMed's Mobi rebranded. Don Clayback COMPLEX REHAB STAKE- HOLDERS visited more than 230 congressional offi ces as part of the National CRT Leadership and Advocacy Conference on May 2. One delegation (top) met former con- gresswoman Gabby Giffords of Arizona.

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