In brief: Lincare settlement, value-based vs. fee-for-service, Beyond HME COO

SPOKANE, Wash. – Lincare has agreed to pay $29 million to resolve claims that it violated the False Claims Act by overbilling Medicare and Medicare Advantage, according to a press release from Vanessa Waldref, the United States Attorney for the Eastern District of Washington. 

The settlement requires Lincare to refund wrongful payments made by Medicare beneficiaries and sets up accountability measures to prevent future fraudulent billing. 

In the settlement announced Aug. 28, Lincare admitted that it improperly billed Medicare, MA Plans, and beneficiaries for oxygen equipment rental payments and co-payments after it had already received three years of payments. Lincare admitted that it lacked adequate controls to ensure that MA Plans and beneficiaries were not improperly billed after three years of rental payments had already been received.  

Lincare additionally admitted that for traditional Medicare recipients, it had controls in place to prevent improper billing, but that those controls were not always effective.   

Finally, Lincare admitted that when Lincare employees raised concerns about Lincare’s billing practices, Lincare officials in its Regional Billing and Collections Office located in Spokane Valley, Washington, and at Lincare’s corporate headquarters in Clearwater, Florida, instructed them that Lincare would continue its billing practices.   

“I am appalled by Lincare’s admitted past practice of putting profits before its obligations to patients and to the Medicare program, and in particular by Lincare’s admitted improper practice of wrongfully collecting co-pays from elderly beneficiaries on fixed incomes and with limited means,” said Waldref. 

Study: Consumers unclear on value-based vs. fee-for-service 

NEW YORK – Employers and consumers are unclear of the difference between value-based care and fee-for-service payments, but when given the definition of value-based payments, prefer it, according to a study from EmblemHealth, a nonprofit insurer.  

"The survey data and information from our research demonstrate that both employers and consumers overwhelmingly prefer value-based care to fee-for-service payment models when they better understand the differences between each model," said Karen Ignagni, CEO of EmblemHealth. "Achieving healthier outcomes more affordably will require all stakeholders to work together to educate the public on the benefits of a value-based care model." 

Key findings of the study include: 

• The concepts of value-based care and fee-for-service payments are widely unknown and misunderstood by both employers and consumers, providing an opportunity for stakeholders to collaborate on education around these concepts. 
• 60% of employers were familiar with the term "value-based care" but only one-third could provide a definition; small group employers had less of an understanding than large group employers and were more likely to be unsure of whether value-based care plays a role in the coverage they offer. 
• Only 26% of consumers surveyed had familiarity with the term "value-based care"; four out of 10 consumers were unsure whether value-based care is offered through their health plan. 
• Quality is important when defining value in health care, and employers and consumers feel health insurers and providers are most responsible for adding value to health care. 
• 42% of employers and 34% of consumers most associate quality of care received with value when thinking about health care, topping out-of-pocket cost (22% and 16%, respectively). 
• Employers felt insurers were more responsible for adding value to their employee's health care; consumers felt that providers should be more responsible for adding value (both groups placed insurers and providers at the top of their lists). 
• Given the definition of value-based and fee-for-service payment models, there is a strong alignment toward the value-based payments compared to the fee-for-service payments across both audiences. 

Mobility City opens new location 

BOCA RATON, Fla. – Mobility City has announced the grand opening of its Mobility City of Hilton Head showroom in Bluffton, S.C. The local franchise will service the counties of Beaufort, Jasper, Hampton, and Allendale, and the Savannah GA Metro. “We are excited to bring our unique brand of customer experience and product knowledge to the Hilton Head area,” said Diane Baratta, CEO. “Our goal is to provide our customers with the best possible solution when they're shopping for mobility equipment, its repair and rental.” Mobility City of Hilton Head offers a wide selection of mobility equipment from the top manufacturers in the industry, as well as a team of certified service technicians who make house calls in vans fully equipped as a “repair shop on wheels” for those who cannot visit the showroom. Charlie Guilbert is the Hilton Head Regional Manager SC/GA. 

Beyond HME names COO 

SARASOTA, Fla. – Beyond HME has named Margaret Lindskog as its new chief operating officer & partner. Lindskog joined Jim Dragatsis in founding AllCall Connect In 2013. As director of operations, she managed more than 500,000 patients and oversaw 200+ employees. After AllCall Connect was acquired by ResMed/Brightree in 2017, she remained in her role leading all call center operations across the US and Canada.  In 2021 Margaret was promoted to senior director of resupply customer success, taking three different customer success teams within Brightree under her leadership to form one cohesive team.  In this position, her team managed more than 400 HME clients, encompassing customer success of both resupply software and SAAS divisions.  

Huma Therapeutics to use AI on disease management platform 

NEW YORK – Huma Therapeutics, a global digital health company, will use Google Cloud's generative AI (GenAI) to enhance Huma's regulated disease management platform. Huma is also exploring the use of Google's GenAI tools to support healthcare professionals (HCP) with better insights to optimize care delivery. "Huma is committed to making healthcare accessible and affordable for everyone and GenAI will play a crucial role in this equitable access,” said Dan Vahdat, Huma CEO & founder. “Our new GenAI applications will help mitigate the pressures on the healthcare workforce that exist worldwide and will reduce burnout in overworked staff. We are committed to the safe and responsible introduction of GenAI into healthcare and will ensure that Huma-ns are kept in the loop, meaning that HCPs will retain control of these health technologies." Huma's technology platform captures a range of vital signs, biomarkers and patient-reported data that are displayed on an HCP dashboard. This allows HCPs to care for many more patients than they would be able to in person, helping to alleviate workforce pressures and expand access to healthcare.