Update: Nichole Medical vs. TriCenturion

From: HME News

by: Liz Beaulieu

PHILADELPHIA – Dominic Rotella, the former HME provider who won an audit on appeal and who is now suing TriCenturion, the CMS contractor that conducted the audit, for $10 million in damages had his day in court April 20.

In the U.S. Court of Appeals for the Third District here, Rotella’s attorney, David Hollar, argued that Nichole Medical Equipment & Supply was driven out of business by TriCenturion’s “unlawful” audit and, therefore, deserves damages. When asked by one of the three judges to put a real value to those damages, Hollar replied:

Is Medicare’s Competitive Bidding Program Killing Seniors?

From: Watchdog Watch

“charts in the CMS report show that death rates were higher in Pittsburgh, where products are competitively bid, compared with Detroit, where there is no bidding.” – Inside Health Policy

CMS claims that there are no adverse health consequences from their “competitive bidding” program for durable medical equipment. The numbers seem to be telling a different story.

An economist at the University of Maryland who studied CMS data concluded that,

“the CMS data through September 2011 show the impact of declines in utilization of Medicare DME. In all cases, the result is a higher risk of death, a higher frequency of ER visits and hospitalization, and longer hospital stays.”

GAO Blasts CMS’ Medicare Advantage Bidding Program — Calls for Demonstration Program’s Cancellation

A GAO report, attached below, harshly criticized the Centers for Medicare and Medicaid Services’ (CMS’) Medicare Advantage (MA) quality bonus payment demonstration program.  The MA program, an alternative to traditional fee-for-service, is based on a bidding system established by CMS.  Congressional concerns about the program’s transparency and accountability may be found here.

GAO concluded:

Death in Pittsburgh?

CMS data appears to show that Medicare beneficiaries in Pittsburgh who receive Durable Medical Equipment (DME) through CMS’ competitive bidding program have higher death rates compared to Detroit which does not yet have DME acquisition through the bidding program.  As an article in Inside Health Policy observed,

For example, charts in the CMS report show that death rates were higher in Pittsburgh, where products are competitively bid, compared with Detroit, where there is no bidding.

Higher death rates of Medicare beneficiaries as a result of competitive bidding was also expected by Professor Peter Cramton of the University of Maryland based on his analysis of CMS data.  As Dr. Cramton explained,

CMS Continues its False Claims

From: VGM

We Need YOU to Keep Fighting to End Competitive Bidding

Beneficiaries Needed to Join in our Efforts!

Almost immediately after CMS announced the Round 1 Recompete, press releases from the agency seemingly poured out of several news outlets. Once again, CMS touted taxpayers’ savings and also indicated that beneficiary access to suppliers was not compromised. In other words, “Lies, damned lies, and statistics” (as made famous by the great Mark Twain). CMS continues to say the program is running smoothly, without any problems. It also released a 16-page report highlighting its claims. Meanwhile, the entire industry knows such claims are untrue.   

CMS Announces Round 1 Recompete

CMS has published their time line for the recompete in Round 1 competitive bidding areas:

Spring 2012

• CMS begins pre-bidding supplier awareness program

Summer 2012

• CMS announces bidding schedule
• CMS begins bidder education program
• Bidder registration period to obtain user ID and password begins

Fall 2012

• Bidding begins

Additional information about ther Round 1 Recompete is available here.

“What are you trying to do, take the very air I breathe? … Just put us out in the street and shoot us. That’s the only next thing you can do.””

From CRE’s DME Hotline: 1-800-613-7678 (Oxford, MS)

“I think our healthcare benefits are regulated by the government, enough as it already is. I worked 50 years for the benefits I have now. They are regulated enough, the government just about runs my life as it is. I don’t get what I worked for already. I think this is just about as much dictatorship as I need. You’ve taken everything I’ve worked for all of my life. What are you trying to do, kill me? I think you’ve taken enough of what I already have. Don’t take anymore. You’ve regulated my life down to where I could barely live as it is. I’m 71 years old. You’ve taken everything I’ve worked for all of my life. What are you trying to do, take the very air I breathe? I have diabetes, I have a bone disease, I have a health problem, I’m on oxygen, I’m on insulin. My God, the next thing you take away from me is going to take my life. Alright go ahead and take my life. Take every other elderly person’s life. Just put us out in the street and shoot us. That’s the only next thing you can do.”

Medicare Bidding Program Endangers Patients, Costs Jobs in Pittsburgh, says American Association for Homecare

PITTSBURGH, April 4, 2012 /PRNewswire via COMTEX/ — The Medicare bidding program for home medical equipment and services (HME) is forcing those providers in the Pittsburgh area to revise operating models, lay off workers, or leave the profession. Medicare beneficiaries are also affected, since many out-of-state providers, with no connection to the community or patients, are assigned to provide critical equipment and services.

How well did the Competitive Bidding Program process work?

From: Home Care Magazine

The 60-day bid window for Round 2 of Medicare’s Competitive Bidding Program closed Friday, March 30. So, providers participating in the program are finished with documentation, the computerized bidding system and most administrative aspects of competitive bidding. Participating providers, please go to the Homecare website (www.homecaremag.com) and in the lower right corner answer a single question about how well the actual process worked.

Round 2: Last minute double-checking and second-guessing

From: HME News

Theresa Flaherty, Managing Editor

BALTIMORE – The bid window for Round 2 officially closed on Friday night, and industry sources say, for the most part, the system worked smoothly. 

“Considering the number of people that are bidding, I have personally heard of very few issues,” said Wayne Stanfield, president and CEO of NAIMES. “From a technical standpoint, the system is working very well.”

That’s a good thing, because at this point in the game, no issue is minor, said Walt Gorski, vice president of government relations for AAHomecare, which spent last week helping providers dot their Is and cross their Ts.