In brief: AAH on cath fraud & CCS on GLP-1s

WASHINGTON – AAHomecare has issued a statement affirming its support for the government to implement real-time monitoring of claims to detect potential fraud and abuse, in response to news reports of potential Medicare fraud by a handful of intermittent catheter companies. 

AAHomecare's statement, which was shared with CMS and Capitol Hill, also reiterates recommendations for federal government initiatives to better monitor DME supplier billing practices and trends, including: 

• Increased monitoring and scrutiny of claims submitted by DME suppliers who are new to the Medicare program. 

• Increased monitoring and scrutiny of claims submitted by DME suppliers that submit claims for new product categories. 

• Closer monitoring of significant increases or spikes in claims submissions for a specific product category over a short period of time. 

• Support of electronic prescribing between physicians and suppliers, which would only allow legitimate and verifiable prescriptions for the benefit and safety of patients while allowing payer insight to mitigate abusive billing practices. 

Additionally, the association’s statement notes that the industry has been working in collaboration with clinical, patient and disability organizations to convince CMS to refine the HCPCS coding system for intermittent catheters.   

“We will continue to advocate for a more nuanced HCPCS coding system for intermittent catheters that would provide program integrity benefits and remain committed to working with policymakers to reduce and eliminate fraud and abuse related to intermittent catheters and the full spectrum of DME products and services,” said AAHomecare. 

CCS survey: Education lacking for diabetes 

DALLAS – CCS engaged independent market research firm PureSpectrum to survey more than 1,500 people living with diabetes to understand their attitude on an array of timely issues, including growing demand for GLP-1 weight loss drugs. 

The survey found 57% of people with diabetes think GLP-1 weight loss drugs alone may be a silver bullet for helping achieve their health goals. 

“GLP-1 weight loss drugs alone are not a silver bullet when it comes to improving the health and well-being of those living with diabetes,” said Dr. Arti Masturzo, chief medical officer at CCS. “These drugs do offer hope for those living with diabetes and others looking to manage obesity, but they should be prescribed in conjunction with hands-on personalized education and coaching, as well as the appropriate medical device technology needed to streamline diabetes self-management.” 

Other findings from the survey: 

• 36% of respondents felt they did not have enough information provided when they were first diagnosed with their condition — or were first responsible for their own care — to help them effectively manage their condition.  

• 71% believe any organization that supports their diabetes care management should also be engaging with them in between doctor visits, yet 41% typically see their clinician only two to three times a year, suggesting a significant gap in support.  

• 94% stated they’d be likely to consistently engage with their diabetes medical supplier as a critical part of their care team. 

• 42% reported experiencing a life-threatening emergency caused by their diabetes. Of that group, 82% also said that the emergency could have been prevented with better support in the management of their diabetes. 

Soleo Health turns 10 

FRISCO, Texas – Soleo Health marked its 10th anniversary on Feb. 24. Led by CEO Drew Walk and COO Craig Vollmer, Soleo Health was founded on the commitment to simplify complex care for patients, and over the past decade, it has become one of the fastest-growing independent specialty pharmacies. Notably, the company has collaborated with more than 22,000 prescribers and delivered care to more than 100,000 patients. “Looking ahead, we remain dedicated to defining the unique requirements of complex specialty pharmacy, focusing on patients with complex, rare and ultra-rare diseases,” said Walk. “Our commitment to excellence has solidified our reputation as a premier health care service provider shaping the landscape of complex specialty pharmacy with our exceptionally talented team of professionals. Through strategic partnerships with manufacturers, payers and providers, we continuously elevate the standard of care, enriching the lives of our patients and enhancing their outcomes.” Soleo Health has 26 pharmacy locations with national nursing coverage and pharmacy licensure in 50 states and is accredited by URAC, ACHC with Distinction in Rare Disease and Orphan Drugs, and The Joint Commission. Additionally, the company operates more than 30 infusion centers throughout the U.S.  

CMS re-awards contract to Noridian 

FARGO, N.D. – Noridian Healthcare Solutions has again been awarded the DME MAC for Jurisdiction D contract by CMS. The $152.8 million contract covers 17 states and three U.S. Territories. Noridian processes more than 13 million fee-for-service (FFS) claims for nearly 25,000 DME suppliers, resulting in $2.6 billion in payments for the contract. “We are immensely proud to receive this re-award,” said Noridian president and CEO Jon Bogenreif. “For nearly two decades, Noridian has diligently served the suppliers and beneficiaries of JD. This re-award reflects Noridian’s exceptional performance, and a well-established commitment to eliminating administrative barriers and enabling access to health care.” Under the contract, Noridian handles nearly 200,000 phone inquiries annually from DMEPOS suppliers in Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington and Wyoming. Jurisdiction D includes 8.7 million beneficiaries and accounts for 24% of the national DME workload. The contract period for the new award includes a base year and the option for six, one-year option periods. 

Wisconsin CRT bill ready for governor’s signature 

MADISON, Wis. – State Senate Bill 592, legislation related to reimbursement under the Medical Assistance program for complex rehabilitation technology wheelchair repairs and accessories, is awaiting the governor’s signature, according to a bulletin from MAMES. The legislation states for HCPCS codes relating to complex rehabilitation technology wheelchair repair and accessories, a reimbursement rate under the Medical Assistance program equivalent to the maximum fee paid in Wisconsin under the federal Medicare program, including fees under the KU modifier, if applicable, should be applied. “Earlier this session we had a huge victory for wheelchair users by eliminating prior authorization and doctors’ prescriptions for CRT repair approvals,” Ted Malkowski, ATP, director of Medicaid affairs and national contracting at Numotion. “SB592 now takes this even further in the ongoing push to create a better process in the repair of complex rehab wheelchairs and provide increased access to wheelchair users.”  

One Health Direct adds maternity products 

DUNEDIN, Fla. – One Health Direct has expanded its product offerings to include a range of maternity products. OHD has recognized the importance of patient education and eligibility with other DME products and will now provide maternity products for their DME partners. "Expanding into maternity products was a logical step for us," said COO Nick Bozzo. "We've been able to assist diabetic patients in better managing their condition by providing them with CGMs. By applying the same principles, we can offer new mothers the medical benefits of a breast pump, which can be beneficial for both the mother and her child. This is just another example of how we continually strive to fulfill our company's mission of prioritizing the patient." OHD says new and expecting mothers are often unaware of the medical benefits, ease of availability and requirements for coverage eligibility of certain maternity products and supplies. To help build awareness, OHD has implemented a communication and education plan for new mothers to assist them in getting these critical maternity products through their insurance. Specifically, most women are not aware that they may be eligible to receive a high-end electric breast pump, per the Affordable Care Act. 

Dexcom to introduce OTC glucose sensor 

SAN DIEGO – Dexcom has received clearance from the U.S. Food and Drug Administration for its Stelo by Dexcom, a continuous glucose monitor that will be available for people with Type 2 diabetes without a prescription. “Dexcom continues to lead innovation in the CGM market, with a long list of first-in-market advances,” said Jake Leach, executive vice president and COO. “Dexcom was the first to connect CGM to multiple insulin delivery devices, the first to connect CGM to a smartphone, the first to replace fingersticks for treatment decisions, and now is creating a new category by bringing the first glucose biosensor cleared for use over-the-counter. Based on our experience serving people with Type 2 diabetes not using insulin, we have developed Stelo with their unique needs in mind.” Stelo will be available for purchase online without a prescription starting summer 2024. To learn more about Stelo: https://www.dexcom.com/en-us/stelo. 

ATF promotes Rogalsky 

NEWNAN, Ga. — James J. Rogalsky has been promoted to senior vice president of rehab technology & adaptive housing at ATF Medical. He joined the company in the fall of 2023 as vice president of client services. In his new role, Rogalsky oversees day-to-day operations of the company’s complex rehab technology, mobility and home modification services, as well as sales, marketing and client services. “Jim has a wealth of experience in our industry and we’re leveraging it to ensure our operations efficiently accommodate growth and ensure comprehensive, patient-centric care for our injured workers,” said Susan Glover-Nelson, co-founder, COO and CFO. Rogalsky has served as an executive in fast-growing workers’ comp companies for more than 30 years. Between 2008 and 2018, he was an owner of Priority Care Solutions, a specialty managed care network in the workers’ comp space. He also held roles with PhysNet, CompDME, LLC, CypressCare/Healthcare Solutions and Tech Health. “By creating fully integrated solutions that combine mobility and adaptive housing solutions, ATF Medical stands out in our field,” Rogalsky said. “It’s a privilege to work with this far-sighted company and our exceptional, caring staff of specialists.”