In brief: Arriva Medical execs settle lawsuit, trustees expect Part B costs to grow

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Friday, April 26, 2019

NASHVILLE, Tenn. – Two former Arriva Medical executives have agreed to pay $500,000 each to settle allegations they violated the False Claims Act.

The settlement resolves the U.S.’s claims that David Wallace and Timothy Stocksdale caused Arriva to submit claims to Medicare that were tainted by kickbacks paid to beneficiaries in the form of free or no cost home blood glucose meters, or waived or uncollected copayments from Nov. 23, 2011, through Aug. 30, 2013.

The settlement also resolves the U.S.’s claims that Wallace and Stocksdale caused Arriva to bill Medicare for medically unnecessary home blood glucose meters during the same period.

Wallace and Stocksdale, both of Florida, co-founded the Coral Springs, Fla.-based mail-order diabetes testing supply company. After selling to Alere in 2011, they remained employed as president and vice president, respectively, until Aug. 30, 2013.

Arriva ceased operations in December 2017 after an appeal seeking to reinstate its Medicare billing privileges. CMS revoked those privileges in 2016, alleging the provider submitted 211 claims for deceased patients between April 15, 2016, and April 25, 2016.

Prior to that, Arriva had been the top provider of mail-order diabetes supplies, receiving nearly $120 million in Medicare payments in 2015.

Arriva and Alere, a Waltham, Mass.-based medical device manufacturer, were acquired by Abbott Laboratories in 2017.

Medicare trustees expect Part B costs to grow steadily

WASHINGTON – Projected costs for the Supplementary Medical Insurance (SMI) Trust Fund, which funds Medicare Part B and D, are expected to grow steadily from 2.1% of GDP in 2018 to about 3.7% GDP in 2038, according to the 2019 Medicare Trustees Report.

The reason: an aging population and rising healthcare costs.

Despite the growth, the SMI Trust Fund is expected to be adequately financed in all years because premium income and general revenue income are reset annually to cover expected costs, the trustees say.

The Hospital Insurance (HI) Trust Fund, which funds Medicare Part A, has a much bleaker outlook, the trustees say: It will only be able to pay full benefits until 2026.

For the 75-year projection period, the HI actuarial deficit has increased to 0.91% of taxable payroll from 0.82% in last year’s report, according to the report.

The reason: a number of factors, most notably lower assumed productivity growth, as well as effects from slower projected growth in the utilization of skilled nursing facility services, higher costs and lower income in 2018 than expected, lower real discount rates and a shift in valuation period.

Inspire racks up more coverage by private payers

MINNEAPOLIS – Inspire Medical Systems has added 10.4 million covered lives with several new coverage policies. Two new Blue Cross Blue Shield Association plans, including Blue Cross Blue Shield Service Benefit Plan, also known as the Federal Employee Program, and BCBS of Tennessee have issued positive coverage policies for the Inspire therapy. Additionally, Medical Mutual of Ohio has issued positive coverage. There have now been 18 positive coverage policies issued by BCBSA healthcare plans, covering about 42 million members. “We are encouraged that to date, half of the 36 Blue Cross Blue Shield healthcare plans have issued positive coverage policies,” said Tim Herbert, president and CEO of Inspire Medical Systems. “Improving access to Inspire therapy for the many patients with obstructive sleep apnea is a key initiative for our team. Our focus is to build evidence to demonstrate the safety and efficacy of the therapy and these strong patient outcomes are expected to lead to further improvements in market access through additional coverage policies.” In all, 29 coverage policies representing 72 million members now cover Inspire therapy. The therapy is an FDA-approved neurostimulation technology that provides a safe and effective treatment for moderate to severe obstructive sleep apnea.

Estrella takes time away from HOMES

NEW BEDFORD, Mass. – Karyn Estrella, president and CEO of the Home Medical Equipment and Services Association of New England (HOMES), is taking a medical leave from the association. During her absence, Lauryn Estrella, Karyn’s daughter and the administrative assistant for HOMES, will be fielding emails and phone calls on her behalf. “We do expect her back but it is unclear when that may be,” states a HOMES email bulletin. Robbin Eusebio will also be at HOMES to assist Lauryn and the association’s board of directors. HOMES invites members and friends to stay up to date on Karyn’s CaringBridge page. She was recently diagnosed with pancreatic cancer.

Oklahoma passes bill to exempt HME from sales tax

OKLAHOMA CITY – The Oklahoma State Senate voted last week to pass H.B. 1262, a bill to make home medical equipment exempt from the sales tax. Currently, HME is taxed between 9.3% and 10.5%, depending on the county. “It’s been a fantastic day for the DME industry and for the citizens of Oklahoma,” said Larry Dalton, president of the Oklahoma Medical Equipment Providers Association. “This bill will save the citizens money. This is a history making day that we will not forget.” The bill takes effect July 1.

iLevel elevates more than 25K consumers

DURYEA, Pa. – Quantum Rehab’s iLevel seat elevation technology is now used by more than 25,000 consumers. Released in 2015, the system promotes independence and conclusion. “With iLevel, our consumers have achieved greater independence to do the things they love,” said Jay Brislin, vice president of Quantum Rehab. “This technology is successful not just because consumers recognize what it can do for them, but also because payers are beginning to realize power seat elevation is a necessity and not a luxury.”

WellSky, CompanyMileage intergration paves way for savings

LENEXA, Kan. – WellSky has integrated into its solution CompanyMileage’s mileage reimbursement solution, a tool that automates mileage calculations, streamlines reporting and ensures accurate reimbursement for WellSKy’s home health care and hospice clients. The integration will also simplify payroll processes, with some agencies reducing mileage expenses by 30%. “WellSky solutions are built to reduce burdens for care providers, and we’re always innovating to find new ways to empower their work,” said Bill Miller, CEO of WellSky. “With the CompanyMileage integration, our clients can immediately save time and money by automating previously manual tasks, so clinicians can maximize time spent caring for patients.”

Wheelchair users: Ready to roll

WASHINGTON – The United Spinal Association will hold its annual “Roll on Capitol Hill” June 23-26. The event is United Spinal’s annual legislative advocacy event to addresses issues that impact the health, independence and quality of life of individuals living with spinal cord injuries and disorders, including disabled veterans. Highlights of the conference include a welcome reception on June 23, an advocacy education and expo day on June 24 and a congressional awards reception on June 25. “I’ve met so many amazing individuals with spinal cord injuries and disorders from across the country, uniting to impact change and fight for disability rights,” says Richard Babgy, a past attendee from Virginia. “That’s what makes Roll on Capitol Hill so rewarding.”