In brief: Fraud bill, LCD for prostheses, diamond anniversary

WASHINGTON – Sens. Mike Braun, R-Ind., and Bill Cassidy, R-La., have introduced legislation to target irregular billing for certain DME and other diagnostic products in the Medicare program. 

The “Medicare Transaction Fraud Prevention Act” directs CMS to create a two-year pilot to oversee Medicare-covered purchasing of DME and other diagnostic testing related products for the 5% of beneficiaries that already receive electronic notices. 

The bill, which would ask beneficiaries to verify certain purchases, would give CMS increased access to vital predictive data, test proof-of-concept for future use, and save hundreds of millions of dollars without overhauling their system, according to Braun and Cassidy. 

Medicare loses approximately $60 billion annually due to fraud, errors, and abuse involving both predatory health care professionals and anonymous organized criminals, the lawmakers say. 

“An annual loss of $60 billion is unacceptable,” Braun said. “It’s time for CMS to strengthen their fraud detection process in order to stop the hemorrhaging of the Medicare trust fund.” 

Rep. David Schweikert, R- Ariz., has introduced a companion bill in the House of Representatives. 

The bill does not authorize any funding, and beneficiaries can opt out at any time.  

CMS proposes changes to coverages for lower limb prostheses 

WASHINGTON – CMS and the DME MACs have published proposed changes to the local coverage determination (LCD) for lower limb prostheses, in a “major leap forward in the care of K2 patients,” according to the American Orthotic & Prosthetic Association (AOPA).  

Under the proposed changes, the agency will now allow limited coverage of microprocessor-controlled knees for select patients who are classified as K2, instead of limiting the technology to patients classified as K3 and above.  

CMS and the DME MACs are currently soliciting public feedback and comments on the proposed LCD changes through March 2, 2024. The agency will also host a public meeting on Feb. 22. 

AOPA is currently reviewing the LCD changes and will provide appropriate feedback and comments.  

View the proposed LCD changes here. 

AAH seeks next Homecare Champion 

WASHINGTON – AAHomecare seeks nominations for the 2024 Van Miller Homecare Champion, who will be honored at the Stand Up for Homecare reception at Medtrade on March 27 in Dallas. Nominees must have a longstanding record of service within the home care community; embody the spirit of caring and generosity, which are the hallmarks of the profession; and have active membership and engagement in AAHomecare. The Homecare Champion award was renamed in 2016 in honor of Van Miller, founder of the VGM Group, a visionary leader for the HME industry. Nominations can be submitted to Sue Mairena, suem@aahomecare.org, by Friday, Feb. 23. Find the nomination form here. 

• Read about last year’s winner, Kam Yuricich. 

Inogen names new CFO 

GOLETA, Calif. – Inogen has named Michael Bourque as CFO effective March 4. Bourque has served since 2021 as treasurer and CFO of Chase Corporation, now owned by KKR & Co. Prior to that, he served as CFO of Keystone Dental, and senior vice president, CFO and treasurer of Analogic Corporation from 2014 to 2018. “I am incredibly excited to announce Michael as the new chief financial officer of Inogen,” said Kevin Smith, president and CEO. “His experience building best-in-class finance teams at Chase, Keystone and Analogic display what makes him uniquely qualified to help Inogen continue to deliver superior respiratory solutions to patients around the world.” Bourque succeeds Mike Sergesketter, who served as interim CFO and is retiring. 

• Read about how Inogen replaced Nabil Shabshab with Smith in November. 

Paragon Healthcare, Brightstar Care join forces 

GURNEE, Ill. – Paragon Healthcare has partnered with BrightStar Care, a home care and medical staffing agency with more than 380 corporate-owned and franchise locations, as its premier partner for home infusion services. Amid an ongoing health care worker and nursing shortage, this strategic collaboration enables Paragon Healthcare to efficiently enhance the delivery of high-quality home infusion services to a broader clientele through BrightStar Care's nurse-led, Joint Commission-accredited care model. “In addition to having more than two decades of success in the home care space and an existing structure for providing in-home infusion nurses, BrightStar Care's core brand values align seamlessly with the mission of Paragon Healthcare," said Ashley Smith, director of Home Nursing Operations for Paragon Healthcare. "We look forward to growing this relationship and expanding our capabilities to efficiently serve more clients with the high-quality home infusion services they need." Paragon Healthcare was recently acquired by Elevance Health, formerly Anthem. Founded in 2002, BrightStar Care is a national home care agency with more than 380 corporate-owned and franchised locations nationwide that provide medical and non-medical home health care services to clients and supplemental care staff to businesses. The company’s corporate and franchise agencies across the country employ more than 15,000 caregivers and 5,700 registered nurses.   

AOPA names Swiggum to board 

ALEXANDRIA, Va. – The American Orthotic & Prosthetic Association (AOPA) has appointed Matt Swiggum to the supplier director seat on its board of directors effective immediately. Swiggum is CEO of Proteor USA, which manufactures custom-made prosthetic medical devices. He brings a wealth of experience in prosthetics, having dedicated his career to advancing the well-being of individuals with limb loss and limb difference. Swiggum has served on the boards of the Orthotic and Prosthetic Activities Foundation (OPAF), California Orthotics and Prosthetics Association (COPA), and the Amputee Coalition, reflecting his commitment the profession and those living with limb loss and limb difference. 

Miller’s celebrates diamond anniversary 

AKRON, Ohio – Miller's has shared a special logo that it will use to celebrate its 75th anniversary this year. “It is very special indeed that Miller’s is still going strong since 1949,” the company posted to social media. “75 years didn’t happen at once. Rather, it was day by day of hard work and dedication by so many that came before us and by our staff members today. This includes many members of the Miller’s family as well as many more with many different last names. We are very proud that we are still a family-owned Company, an Ohio-owned company, and operating with family values. It is especially gratifying to know that we have positively impacted thousands and thousands of our clients’ lives over these many years.” Miller’s, which is based here, recently opened a fifth location in Ohio in Columbus. It also has offices in Cleveland, Youngstown and Canton.