Page 7 - HME Business, June 2019

More industry intelligence is available at hme-business.com.
FREE On-Demand Webinars
The HME Business web site is currently offering several free webinars to help you improve your business and tap into new opportunities:
In “Winning Over Busy Referrals,” high-energy sales and management coach Ty Bello, president and founder of Team@Work, offers a solution to the dilemma HME sales professionals face when it comes to reaching referrals while still respecting their time. Sponsored by PlayMaker Health.
In “Double-Digit HME Sales Growth — the Only Thing in the Way Might Be you,” Bellow returns to review the elements of a strategic HME sales plan; how providers can use data to drive their sale efforts; and the step by step process of building
a strategic sales plan that will produce results. Sponsored by PlayMaker Health.
“Understanding Advantages of Patient Home Delivery,” sees Brent Poythress, vice presi-
dent of hme corporate accounts at McKesson Medical-Surgical, Jon Pildis, vice president of materials management & supply chain analytics
at McKesson Medical-Surgical, and Carl Roan, national director of operations for HME at Thrive Skilled Pediatric Care, discuss how Patient Home Delivery (PHD) can drive efficiency, and key questions to consider and data to review if a provider wants to shift toward PHD. Sponsored by McKesson Medical-Surgical.
In “Understanding the Group 2 Complex Rehab Opportunity,” John Wright, executive vice president of sales management and business development for Shoprider Mobility Products Inc., and Martin Szmal, president of The Mobility Consultants, talk about the business and care case for Group 2 Complex Rehab, funding, staff requirements and resources for providing those items. Sponsored by Shoprider Mobility Products.
In “eReferrals and ePrescriptions: Put the “E”
in HME,” speakers Nick Knowlton, vice presi- dent of Business Development for Brightree, and Gary Bartlett, Brightree’s product manager for Healthcare Interoperability, explain why the time is right for providers to explore eReferral and ePrescription, which are becoming increas- ingly essential in U.S. healthcare. Sponsored by Brightree LLC.
Learn more about and watch all HME Business webinars at hme-business.com/webinars.
Operation Brace Yourself Notches First Sentencing
Georgia DME CEO sentenced to more than three years plus fines and restitution for involvement in history-making Medicare fraud.
Roderic Bain, CEO of a string of Savannah, Ga.-based DME businesses has been sentenced to more than 40 months in prison for his part in the Medicare fraud ring that was recently brought down by Operation Brace Yourself.
Bain pled guilty to one count of False Statements Relating to Health Care Matters and in addition to his prison time, he agreed to pay more than $1.9 million in fines and restitution, said Bobby Christine, U.S. Attorney for the Southern District of Georgia.
According to court documents, Bain oversaw a multi-year scheme resulting in nearly $10 million in claims billed to Medicare. Working with others, Bain operated a network that paid kickbacks to obtain patient information, specifically that of Medicare patients. Through a third-party biller, Bain would then bill Medicare Part B and Part C for medical equipment and orthotics, including a variety of back and knee braces that were not ordered as medically necessary by a physician.
“Schemes like this put greed before need — using the identities of those who are assumed to be medically fragile to exploit programs intended for the benefit of patients,” Christine said. “Ultimately, such fraud hurts all patients by further straining the limited funding available for healthcare in an already struggling system.”
Bain’s enterprise was linked to the larger, national fraud uncovered by the multi-agency Operation Brace Yourself crackdown, which included the FBI and the Department of Health and Human Services Office of the Inspector General (HHS-OIG). That
investigation broke up one of the largest healthcare fraud rings in U.S. history, which involved telemar- keting companies, licensed medical professionals, and 130 HME/DME businesses that allegedly bilked $1.2 billion out of Medicare through claims for fraudulent orthopedic brace prescriptions.
In terms of scale, Operation Brace Yourself led to the execution of more than 80 search warrants in 17 federal districts with charges against 24 defen- dants, but that only tells part of the story. The fraud ring was extensive, according to the DOJ, which reported that some of the defendants allegedly controlled an international telemarketing network involving call centers in locations as far-flung as the Philippines and Latin America.
“Roderic Bain is only one piece of the puzzle, who for just his part in a nationwide scheme was responsible for nearly $10 million in fraudulent Medicare claims,” said Chris Hacker, Special Agent in Charge of FBI Atlanta. “That is a snap- shot of how prevalent the problem of healthcare fraud is. Every tax-paying citizen is a victim when providers like Bain are driven by personal greed. We are proud of the work our agents and law enforcement partners are doing, and will continue to do, to stem this scourge on our federally- subsidized programs.”
Operation Brace Yourself investigation remains ongoing. Any doctors, medical professional, providers or beneficiaries who believe they have witnessed fraud or have been affected by it can contact the FBI hotline at 1-800-CALL-FBI.
CMS Solidifies Dates for Expanded Prior Authorization
Prior authorization for most new codes added to the program goes into effect on July 21, with PA for the remainder to going into effect on Oct. 21.
The implementation dates for the new HME categories being added to CMS’s national Prior Authorization program will go into effect on July 21, except for support surfaces, which will be rolled out in two phases.
In a Dec. 30, 2015 final rule, CMS added seven power mobility device codes and five therapeutic support surface codes. Where the support surfaces are concerned, one phase that covers California, Indiana, New Jersey, and North Carolina, will implement those codes July 21. CMS will implement prior authorization for those codes nationally on Oct. 21.
A statement from the American Association for Homecare said the organization was supportive of prior authorization for certain DME, and that prior authorization offered benefits for providers, such as guaran- teed payment for items that met prior authorization and audit protection for certain claims.
That said, the organization argued that not all items were suited to prior authorization.
“CMS has a 10-business day timeline to make an initial PA decision, and two business days for the expe- dited review process for certain situations,” a statement from the organization read. “AAHomecare is concerned about the potential impact on timely access to care for beneficiaries in need of support surfaces.”
More information can be found at the CMS prior authorization website at bit.ly/DMEpriorauthorization.
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