In brief: Lincare lawsuit, UnitedHealthcare prior auths, O&P finalists 

CLEARWATER, Fla. - Lincare has filed a lawsuit in Connecticut district court against former CEO Crispin Teufel, who plans to join competitor AdaptHealth on Sept. 1, for breach of contract, breach of duty of loyalty and misappropriation of trade secrets. 

Lincare seeks a temporary restraining order, preliminary and permanent injunctive relief, damages and attorney fees. 

“Since defendant’s resignation, plaintiffs have uncovered evidence demonstrating that defendant used Dropbox, a cloud-based file transfer software, to effectuate an extensive exfiltration of Plaintiffs’ trade secrets, confidential information and data in the days immediately preceding his resignation, all for his own personal benefit and/or that of AdaptHealth,” the lawsuit says. “For example, just prior to Defendant’s resignation, he archived large ‘.pst’ files associated with his Lincare email account, uploaded those emails to a Dropbox account associated with his personal email address, shared them with an undisclosed computer, accessed them on that undisclosed computer, and then deleted the files from his computer. This action, standing alone, is cause for grave concern and supportive of emergency injunctive relief.” 

AdaptHealth named Teufel its next CEO in June, succeeding Steve Griggs, who announced his retirement earlier this year. 

Lincare also alleges that it has uncovered evidence that Teufel engaged in extended discussions with AdaptHealth when Lincare was in final negotiations over terms and conditions for a major contract with a Medicare Advantage HMO provider. 

“Although Lincare had been initially awarded a contract, the defendant ultimately recommended during these negotiations that plaintiffs not pursue the contract,” the lawsuit says. “Thereafter, AdaptHealth pursued and successfully finalized the contract with the same provider.” 

AdaptHealth and Rotech in May were awarded contracts from Humana to provide home medical equipment to about 1 million Medicare Advantage HMO members. 

In a Form 8-K, AdaptHealth acknowledges the lawsuit but noted that it is not named as a defendant. 

“AdaptHealth has contractually prohibited Mr. Teufel from disclosing or using any confidential or proprietary information belonging to Linde Inc. or Lincare Inc. in connection with his employment at AdaptHealth,” the company stated. “AdaptHealth is closely monitoring the lawsuit and any potential effect on Mr. Teufel’s start date.” 

UnitedHealthcare drops certain prior authorizations 

EDINA, Minn. – UnitedHealthcare says it will begin a two-phased approach to eliminating the prior authorization requirement for many procedure codes starting Sept. 1, 2023, to help reduce the administrative burden on health care professionals and their staff. 

This move will reduce the payer’s overall prior authorization volume by nearly 20%. 

“This is part of our comprehensive effort to simplify the health care experience for our members and network health care professionals,” the payer stated. “While prior authorization remains an important tool to address clinical quality and safety, as well as fraud, waste and abuse, we also know that fewer prior authorizations can help streamline care delivery.” 

UnitedHealthcare will eliminate the codes as follows: 

• On both Sept. 1 and Nov. 1: UnitedHealthcare Medicare Advantage, UnitedHealthcare commercial, UnitedHealthcare Oxford and UnitedHealthcare Individual Exchange plans 

• Nov. 1 only: UnitedHealthcare Community Plan 

The payer says it will remove some codes across select benefit plans, but there will be differences and health care professionals and their staff should consult each benefit plan. 

In 2024, UnitedHealthcare says it will implement a national Gold Card program for provider groups that meet eligibility requirements. These groups will follow a simple administrative notification process for most procedure codes, rather than the prior authorization process. 

Pharmacy groups highlight new audit on PBMs 

WEST LINN, Ore. - The Oregon State Pharmacy Association and the National Community Pharmacists Association support the Oregon Health Authority’s recommendation that the state “should enact legislation that focuses on patient and pharmacy protections and increasing transparency in the prescription drug supply chain.” The recommendation, which was part of the state’s recent audit report on PBMs, builds on a 2022 report OSPA released in collaboration with 3 Axis Advisors that found PBMs in the state are reimbursing pharmacies at different rates while at times charging Medicare and Medicaid higher prices. “This audit, along with our independent report, provides unwavering support for why PBM reform is needed in Oregon,” said Brian Mayo, executive director at OSPA. “OSPA will work in partnership with our state legislators to pass PBM bills during the 2024 legislative session. PBMs manipulated the system in 2023 and we won’t let it happen again.” The NCPA says the audit underscores the importance of Congress passing meaningful Medicaid managed care reform that prohibits spread pricing, provides increased transparency and ensures fair pharmacy reimbursement in all state Medicaid managed care programs. These specific reform provisions are currently included in PBM reform packages in both the U.S. Senate and House of Representatives. “Momentum is growing in Washington for investigations into and reforms of PBMs, and this audit adds fuel to the fire,” said NCPA CEO B. Douglas Hoey, pharmacist, MBA. “Stopping PBMs from abusing employers and taxpayers through harmful spread pricing and creating pharmacy deserts through underwater reimbursements is a priority of NCPA’s and should be a priority in Oregon. We’re eager partners in getting these policies over the finish line in the state and nationally as well.” 

Belluscura marks large purchase order 

LONDON and PLANO, Texas – Belluscura has received purchase orders for more than 6,500 of its DISCOV-R portable oxygen concentrators, representing about $15 million of potential revenue. The company plans to begin initial production of the POC by the end of this quarter. "We are very excited about the overwhelming interest in the DISCOV-R by online retail sellers and other medical equipment providers,” said Bob Fary, senior vice president of global sales. “Following the pre-market launch of the product and the patient usability study in June, initial feedback suggests we will receive the same or greater level of interest from leading home healthcare providers once it is launched commercially." Recently, Belluscura signed several distribution agreements with medical device distributors and other home health care providers, including a distribution agreement with a division of McKesson and a marketing agreement with https://www.hmenews.com/article/belluscura-increases-visibilityGoodRx.  

AAH taps Plauché to drive nat’l recognition for HME 

WASHINGTON – AAHomecare has tapped Ashley Plauché to lead a new initiative focused on elevating the HME industry’s value proposition. As the association’s new senior director of brand marketing, Plauché will lead AAHomecare’s branding and identity efforts, spearhead market research and cultivate strategic partnerships to drive national recognition of HME with legislators, payers and influential stakeholder groups. “Putting additional resources toward strengthening the brand identity of the HME sector, including developing messaging and stories that better showcase the incredible value of home care, was one of the primary recommendations coming out of our recent strategic planning session,” remarks Tom Ryan, AAHomecare president & CEO. “Ashley is a dynamic leader who combines strategic thinking, persuasive communication and advocacy prowess with an infectious passion for our industry and those we serve. Our board leadership enthusiastically supported our recommendation to have Ashley take on this major undertaking, and her colleagues on the AAHomecare team are already familiar with the energy, creative thinking and follow-through she brings to this new role.” Plauché was previously AAHomecare’s director of membership and public relations. The association has also started a search for a new project manager to manage its member-driven councils and related work groups, as well as contribute to other activities.  

Finalists for O&P Woman of the Year announced 

WATERLOO, Iowa – The Orthotic and Prosthetic Group of America has announced the four finalists for the 2023 O&P Woman of the Year Award. They are: 

• Charu Bhanti, co-founder of CPO Services  

• Marita Dorsch-Carozza CP, FAAOP, senior surveyor with American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC)  

• Teri Kuffel, JD, vice president and founding co-owner of Arise Orthotics & Prosthetics and president of AOPA  

• Nikki Grace-Strader, director of North American operations with Osseointegration International 

The winner of the award will be announced in the OPGA booth (#405) at the AOPA National Assembly on Sept. 7 at 9:45 a.m. ET. “We’re excited to recognize these outstanding women who positively impact the O&P profession,” said Adam Miller, president of OPGA, a division of VGM & Associates. “Each of the finalists exemplify everything that is exceptional about the O&P community, and we look forward to recognizing the winner.” The annual award, sponsored by Össur and presented by OPGA, is open to all women who work in the O&P profession. Nominators were encouraged to provide examples of how the nominee has made significant contributions throughout her career to serve her patients, community, business and the O&P profession. Finalists were selected by a committee of O&P professionals. 

VGM offers business solutions 

WATERLOO, Iowa – VGM & Associates has released its third playbook of 2023: “Business Solutions to Optimize Success in DMEPOS.” Areas of focus in this playbook include embracing new and emerging technology, such as artificial intelligence (AI); optimizing for efficient operations to reduce cost and increase revenue; and welcoming innovation to enhance patient care. “VGM understands that the DMEPOS industry can be filled with specific pain points,” says Krista McNurlen, senior vice president, marketing, VGM & Associates. “Our hope with this latest playbook is that DMEPOS providers discover the solutions they need for their business to succeed and continue providing the necessary services to their customers.” Members can download their copy at vgm.com/playbook.