AAHomecare discusses audits with GAO

From: HomeCare Magazine

WASHINGTON, D.C., Jan. 16, 2013—Last week the American Association for Homecare met with the Government Accountability Office (GAO) to discuss the post-payment audit problems that homecare providers face. GAO, which is the investigative arm of Congress charged with examining matters relating to the receipt and payment of public funds, is likely to issue a report on audits of Medicare providers later this year.

The GAO requested this meeting with AAHomecare to answer several questions from Congress regarding the extent to which CMS has established consistent post-payment claims review criteria across contractors, how CMS determines that contractors’ post-payment claims review criteria are valid and clear, and to what extent CMS prevents duplicative post-payment claim reviews.

Science News examines Medicare bidding program

From: Home Care Magazine

WASHINGTON, D.C., Jan. 10, 2013—The Jan. 7 issue of Science News attacks the mathematical underpinnings of Medicare’s competitive bidding program. According to the American Association for Homecare, the article by Julie Rehmeyer states that “Medicare could waste billions of dollars, bankrupt small businesses and leave seniors without crucial medical equipment, some economists warn, with a new auction-based purchasing plan that ignores mathematical principles of competitive bidding… As a bidder in this system, the rational thing to do is to bid really, really low. After all, your bid doesn’t determine what you’ll be paid.”

Devil is in the details of a new Medicare plan to buy medical supplies

From: Science News

By Julie Rehmeyer

Medicare could waste billions of dollars, bankrupt small businesses and leave seniors without crucial equipment like oxygen tanks and wheelchairs, some economists warn, with a new auction-based purchasing plan that ignores mathematical principles of competitive bidding.

The new plan began with an apparently good idea: Medicare has started buying durable medical equipment through a competitive bidding process rather than through fixed prices influenced by industry lobbying. In theory, this could save the government a big chunk of the $14 billion it has spent on such equipment in a year. But in reality, mathematicians and economists say, the bidding system Medicare has chosen is so flawed it will create chaos in the market, fail to meet the demand and waste money.

Velazquez introduces bidding repeal bill

From: Home Care Magazine

WASHINGTON, D.C., Jan. 3, 2012—Yesterday Rep. Nydia Velazquez (D-NY) introduced a bill, H.R. 27, to repeal the Medicare bidding program. The full text of the bill is not available yet but it is described as legislation “to amend title XVIII of the Social Security Act to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS), and for other purposes.” Velazquez is the ranking member of the House Small Business Committee.  The bill was referred to the Small Business Committee in addition to the Ways and Means and Energy and Commerce committees. The American Association for Homecare is pleased that Congresswoman Velazquez recognizes the serious problems with the bidding program. It is committed to working with her and other members of Congress to stop the program and replace it with the Market Pricing Program (MPP). Learn more at www.aahomecare.org.

New sense of urgency for MPP

From: HME News

‘We have another bite of the apple’

by: Liz Beaulieu

WASHINGTON – With no time to lick their wounds, industry stakeholders are now targeting a must-pass bill to address a series of spending cuts as a potential vehicle for their market-pricing program (MPP).

The “fiscal cliff” deal, which did not include language to replace competitive bidding with MPP, delays $130 billion in automatic spending cuts until March 1. That gives stakeholders a small window to resurrect the program.

“Fiscal Cliff” Deal Has Consequences for Pharmacies

Editor’s Note:  Unfortunately, CRE’s repeated warnings about the expansion of competitive bidding are proving to be true.

From: Pharmacy Times

Daniel Weiss, Senior Editor

Medicare Bidding Blamed For Cutbacks

Editor’s Note:  Every independent expert who has examined Medicare’s “competitive bidding” program for home medical equipment has determined that it will fail.  Hundreds of economists, including Nobel laureates, and researchers working under a National Science Foundation grant and the Congressional Budget Office have all reached a similar conclusion.  HHS/CMS has been deaf to the science community and pursued their own deeply flawed plan.  Now the human toll is starting to be felt.  The article below explains why Congress must pass H.R. 6490 – The Medicare DMEPOS Market Pricing Program Act of 2012.

From: CBS/Miami

OIG: Very little physician solicitation due to bid program

Editor’s Note:  Widespread ethical behavior by DME providers is no surprise to anyone familiar with the industry.  The OIG is deeply wrong, however, in claiming that the uncompetitive bidding program reduces negative behavoir when what the CMS bidding program really does is reduce consumer choice and the supply security of life-sustaining home medical equipment for Medicare beneficiairies.

From: HME News

WASHINGTON – The drastic reimbursement cuts that went into effect as part of Round 1 of competitive bidding haven’t caused HME providers to solicit physicians to prescribe a different brand or mode of delivery, according to a new government study.

MPP: Co-sponsor tally rises, watchdog group tries another tack

From: HME News

by: Theresa Flaherty

WASHINGTON – The week before Christmas, HME industry stakeholders wrapped up seven more co-sponsors for H.R. 6490, bringing the total to 87.

“This demonstrates significant strength for this bill,” said Walt Gorski, vice president of government affairs for AAHomecare. “It’s not easy to get 80 or 90 co-sponsors on anything. Everyone is working hard to move the bill in any legislative vehicle this year.”

As the long holiday weekend advanced, it was looking like the industry might get a little extra time to do just that. The latest attempt by lawmakers to avert a looming fiscal crisis failed Dec. 20, leaving open the possibility that a solution could be pushed into the new year.

Yet More Expansion of Competitive Bidding Proposed

From: HME News

OIG: CMS pays too much for braces

WASHINGTON – The Office of Inspector General (OIG) recommends in a new report that CMS lower the fee schedule amount for certain back braces through competitive bidding or inherent reasonableness.

Medicare paid more than $96 million for L0631 back orthoses in 2011, nearly four times what providers paid to acquire them. Between July 1, 2010, and June 30, 2011, the average Medicare allowable for the orthoses was $919; the average supplier acquisition cost was $191, according to the report.