Page 11 - HME Business, May 2019

supplier needs to talk to a healthcare attorney
that has experience with this area because there is certainly a possibility if not a likelihood that that type of arrangement is legally unacceptable.”
Broader Enforcement
Notably, there was an unexpected bright spot in this recent bust: Ryan, van Halem and Baird all pointed out that HME/DME providers weren’t the only enti- ties that Federal authorities swept up in the opera- tion. Typically in these operations, because the HME provider is at the flashpoint of the fraud, the Feds mainly pursue the provider, which makes it seem
like HMEs are the only businesses engaged in such schemes.
“Normally, when you think of a government investigation, you think that the government’s going after the suppliers or providers or whoever that clini- cian is, whoever’s billing the Medicare program,” Baird explained. “But here, this is a very wide net. The Department of Justice and other government agencies are going after all of the players in this type of arrangement.”
“I’m really, really happy to see the fact that they’re actually going after the lead generation companies and these telehealth doctors,” van Halem said. “This is how this all started.”
“I do think it’s important that all the players got caught,” Ryan added. “I mean, it’s unfortunate when they talk about telemedicine and it’s a very
small, unique piece of telemedicine and the fact that these were typically phone calls from physicians trying to quantify an individual for the need for it. But, more often than not, they were just high-pres- sure salespeople who were intimidating patients into accepting these goods when, in fact, they did not need them.”
The Industry Fallout
The initial conclusion most HME/DME profes- sionals will likely draw from the scandal is that
it will tarnish the reputation of the thousands of providers working honestly and diligently within the Medicare system, and that there could be additional grief to come in the form of additional regulatory requirements.
There is some truth to that. For instance, CMS added OTS braces to competitive bidding, and
we are sure to see reimbursement for those items drop as a result. Then again, van Halem noted that CMS probably set reimbursement for those items too high to begin with, so OTS braces were likely to have been added to bidding regardless.
“I think it has more to do with the overall utiliza- tion and the overall spend,” Ryan added. “So, when you look at the spend, you look at the utilization. They were product categories that, by statute could be included in competitive bidding. ... At the end of the day, I think the criteria was overall utilization, overall dollars, and overall spend.”
For providers that are doing legitimate work providing orthopedic braces, Ryan said that they should fight any impulses to fret or worry, and instead rely on their reputations as reliable partners.
“The providers that are working for the normal referral channels — the physicians and physician’s offices, that provide these products legitimately — don’t really have to do anything because they’re not going out looking for the patient and putting a seed in their head that they have a need,” he advised. “They’re hearing from the referral source who knows they’re a legitimate provider and they get the call and they fulfill the need of the referral source and do all the requirements that are necessary in order to bill the Medicare line.
“So, I don’t think they need to be over-reac- tive,” Ryan continued. “I think that they can just
be relieved, like we are, that this bad part of that product category that we’ve known has existed with extremely aggressive telemarketing maybe has had the wings chopped off of it.”
When asked whether or not the recent news could hurt the industry’s advocacy efforts or under- mine relationships on Capitol Hill, Ryan emphatically replied “absolutely not” and added that the indus- try’s legislative and regulatory positions stood on firm foundations.
“That old, ‘we’re all in the same basket and painted with one broad brush’ era is long, long gone,” he said. “Our credibility is solid.”
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