In brief: Trumps picks Oz, DOJ sues UnitedHealth, Alabama covers seat elevation & more 

WASHINGTON – President-elect Donald Trump has named Mehmet Oz, the celebrity physician known as Dr. Oz, as his pick for CMS administrator, according to online news reports. 

Oz, 64, ran for Senate in Pennsylvania in 2022, ultimately losing to Sen. John Fetterman, D-Pa., and has been a Trump ally ever since, according to reports. 

“Dr. Oz will work closely with Robert F. Kennedy Jr. to take on the illness industrial complex and all the horrible chronic diseases left in its wake,” Trump said in a statement Tuesday. “Dr. Oz will be a leader in incentivizing disease prevention, so we get the best results in the world for every dollar we spend on health care in our great country.” 

Last week, Trump named Kennedy, an activist, as his pick to lead the U.S. Department of Health and Human Services. 

As CMS Administrator, Oz would oversee a broad agency that provides coverage through Medicare, Medicaid and other programs to more than 160 million people. He has been a major supporter of Medicare Advantage, the program’s private sector alternative that has grown in popularity but has come under intense scrutiny for care denials and alleged overbilling. 

Oz, like RFK Jr., must be confirmed by Congress. 

Alabama Medicaid to cover power seat elevation 

‘NCART remains in hot pursuit of coverage for power seat elevation in several other states’ 

MONTGOMERY, Ala. – The Alabama Medicaid program will cover E2298, power seat elevation system, for adults 21 and older starting Jan. 1, 2025, according to NCART. 

“NCART remains in hot pursuit of coverage for power seat elevation in several other states and greatly appreciates the support of our provider and manufacturer members as we seek to get this enabling technology covered in all 50 states,” the group stated in an email bulletin. 

NCART says it was assisted in the win by Cathy Carver, PT, DPT, ATP/SMS, at University of Alabama Birmingham/Spain Rehabilitation Center and the Alabama Durable Medical Equipment Association. 

For coverage in Alabama, providers will need to submit a prior authorization. The state Medicaid program will continue to cover power seat elevation for children under 21, also with a PA. 

Alabama is limiting coverage to one power seat elevation system per two calendar years for both adults and children. 

Background: 

• In 2023, CMS posted a final benefit category determination and national coverage decision for seat elevation systems as an accessory to power wheelchairs.   
• In March of 2024, the agency established a new code, E2298, for seat elevation systems and set reimbursement to about $2,000 effective on April 1. 
• In addition to increasing access to power seat elevation through Medicaid, stakeholders are also working to increase reimbursement for the systems. 

DOJ sues UnitedHealth to block Amedisys deal 

WASHINGTON – The U.S. Department of Justice, together with the attorneys general of Maryland, Illinois, New Jersey and New York, has filed a civil antitrust lawsuit to block UnitedHealth Group’s proposed $3.3 billion acquisition of Amedisys because it would eliminate competition between the two companies. 

Since UnitedHealth’s acquisition of LHC Group, a competitor of Amedisys, in 2023, UnitedHealth and Amedisys have been two of the largest home health and hospice providers in the United States. Merging the two companies would harm patients who receive these services, insurers who contract for home health services and nurses who provide home health and hospice services, according to the lawsuit. 

“We are challenging this merger because home health and hospice patients and their families experiencing some of the most difficult moments of their lives deserve affordable, high quality care options,” said Attorney General Merrick B. Garland. “The Justice Department will not hesitate to check unlawful consolidation and monopolization in the healthcare market that threatens to harm vulnerable patients, their families, and health care workers.” 

According to the lawsuit, UnitedHealth’s market share after the transaction would make the merger presumptively illegal in: 

• Hundreds of local home health care markets, with an annual volume of commerce exceeding $1.6 billion annually, in 23 states and the District of Columbia; 
• Dozens of local hospice markets, with an annual volume of commerce exceeding $300 million annually, in 8 states; and 
• Hundreds of local markets for home health and hospice nurse labor, employing at least 8,000 nurses, in 24 states. 

To address some of the overlaps between UnitedHealth and Amedisys, UnitedHealth has proposed to divest certain facilities to VitalCaring Group (VitalCaring), but the lawsuit alleges that does not alleviate harm in more than 100 home health, hospice and labor markets, which generate at least $1 billion in revenue annually, serve at least 200,000 patients and employ at least 4,000 nurses. 

The DOJ also seeks civil penalties against Amedisys for allegedly falsely certifying compliance with its obligations under the Hart-Scott-Rodino Antitrust Improvements Act of 1976 (HSR Act). The complaint alleges that Amedisys violated the HSR Act because, at the time of its sworn certification, the company failed to produce millions of documents or disclose the deletion of other documents. For each day that Amedisys was in violation of the HSR Act, the government seeks a monetary penalty of up to $51,744, as authorized by statute. 

AmeriCare makes Top Workplace list 

DETROIT – AmeriCare Medical has once again been named as one of Michigan’s Top Workplaces for 2024 by the Detroit Free Press. Each year, the list recognizes top businesses across the state based on insights from employees gathered through a confidential survey conducted by Energage. The survey examines 15 culture drivers that shape an organization’s success, including factors like alignment, executive and connection. "AmeriCare Medical's greatest asset is our team," stated Greg Jamian, president and CEO. "Their commitment to innovation and growth has been fundamental to our success, and the strength of our organization is a direct result of their talent and dedication." AmeriCare Medical, which is accredited by the Community Health Accreditation Program (CHAP), is the parent company of AmeriStaff Nursing Services, Sun Medical Equipment & Supplies, Rx iV Infusion Pharmacy and QCN Home Health Care. 

InfuSystem adds audit expert to board 

ROCHESTER HILLS, Mich. – InfuSystem has appointed Ronald Hundzinski as independent director of the company’s board of directors. He will serve as a director until he stands for election at InfuSystem’s next annual shareholders meeting in May. “We are pleased to welcome Ron to InfuSystem’s board,” said Scott Shuda, chairman of the board. “He adds both accounting and finance depth to our oversight and committee work and brings significant operating experience and acumen that will be valuable as the company increasingly diversifies its business.” Hundzinski has served for the past four years as chairman of the board of directors of Gentherm, a more than billion-dollar market capitalization public company. He also served on the company’s audit committee. Hundzinski served as the CFO and an executive director of TI Fluid Systems from January 2020 until his retirement in April 2023. 

BOC honors Wendy Miller for extraordinary service 

OWINGS MILLS, Md. – The Board of Certification/Accreditation has named Wendy Miller, BOCO, LO, CDME, as the recipient of the 2024 Jim Newberry Award for Extraordinary Service. Miller, who professionally retired from the BOC in December 2023, served the organization for 30 years, including as facility accreditation manager, chief credentialing officer and special assistant to the CEO. “There are few people who have served BOC for so many years and in so many capacities,” said Cameron Stewart, BOCO, BOCP, chairman of BOC’s board of directors. “Wendy is very deserving to be among the ranks of BOC’s Newberry recipients. It is one of BOC’s highest honors, and our board of directors is proud to recognize Wendy for her many accomplishments and contributions.” The Jim Newberry Award for Extraordinary Service is named in honor of longtime BOC practitioner, board member and leader James Newberry, Jr., BOCP, BOCO, BOCPD, who passed away in 2016. The award recognizes outstanding individuals who perform extraordinary service to BOC, the community of stakeholders BOC serves and those who live out the superior example modeled by Newberry during his more than four decades in the field of orthotics and prosthetics. Miller’s contributions at BOC also include serving on the BOC board for six years and playing a pivotal role in creating the organization’s orthotic fitter (COF) and mastectomy fitter (CMF) certifications. Her contributions have also been recognized with a National Association for the Advancement of Orthotics & Prosthetics (NAAOP) Leadership Award. "For three decades, I had the opportunity to see BOC grow beyond what I could have ever imagined—both from the perspective of a volunteer and a staff member," said Miller. "I am incredibly grateful to be recognized as BOC's 2024 Newberry Award recipient and honored to continue to play my part in the organization's incredible story and history." 

VGM’s Jeremy Kauten receives tech award 

WATERLOO, Iowa – VGM Group has announced that CIO Jeremy Kauten has been recognized as a winner of the 2024 Info-Tech CIO Awards in the Large and Enterprise Organization Division. Since 2016, The Info-Tech CIO Awards have honored IT leaders who deliver significant value to their organizations and achieve remarkable satisfaction scores. “It is such an honor to receive an Info-Tech CIO Award,” said Kauten. “This recognition is a testament to the hard work and dedication of our entire team at VGM Group. Together, we have embraced innovation and collaboration to drive our IT initiatives forward, ensuring we deliver exceptional value to our customers and stakeholders. I am grateful for this acknowledgment and look forward to continuing our journey of excellence in technology and service." Winners of the award were selected from a competitive pool of hundreds of candidates, based on assessments from their direct business stakeholders. The award is presented by Info-Tech Research Group, a global leader in IT research and advisory that serves more than 30,000 IT and HR professionals. To view the full list of winners and learn more about the CIO Awards, please click here. 

CMS fixes supplies denials 

WASHINGTON – CMS recently implemented a fix for an incorrect edit denying claims for disposable medical supplies for Medicare beneficiaries if the date of service was the same as the discharge date from the home health agency claim, according to AAHomecare. For years, providers often received denials on their claims due to unreported open Part A home health episodes that were not visible when they checked beneficiary eligibility, and as a result, these providers have lost about $11.5 million per year, the association says. “This is an important first step in our engagement with CMS about suppliers’ challenges,” said Kim Brummett, senior vice president of regulatory affairs for AAHomecare. “While it addresses the issue of those who have the date of service as the same date of discharge from a home health agency, conversations continue with CMS to explore potential alternatives for suppliers to mitigate the losses and to know there is a potential home health episode open.” This issue was raised by a member in AAHomecare’s Woundcare Work Group and prompted a hybrid initiative of the Regulatory Council and Medical Supplies Council to, ultimately, engage CMS. 

Abbott opens new facility for sensors, CGMs 

ABBOTT PARK, Ill. – Abbott on Nov. 18 held a ceremony to celebrate the official opening of a state-of-the-art manufacturing facility in Kilkenny, Ireland, part of its €440 million investment in the country. The new 30,000-square-meter Kilkenny facility is producing FreeStyle Libre 3 sensors and the latest generation in Abbott’s continuous glucose monitoring portfolio for people living with diabetes. "This is our latest commitment to providing innovative care and supporting people with diabetes to live healthier lives," said Robert Ford, chairman and CEO, Abbott. "The state-of-the-art Kilkenny facility will have the highest production of Libre sensors in the world to help meet the growing global demand for our world-leading FreeStyle Libre portfolio." Abbott’s Kilkenny facility is fully electric, powered by six air-to-water heat pumps, and has nearly 600 solar panels on the roof. It also features tanks for collecting rainwater to use onsite. Outside Ireland, Abbott is expanding its manufacturing capacity across Europe with a further £85 million investment in its Witney facility in Oxfordshire, U.K. 

Tech Talks returns to Medtrade 

DALLAS – Medtrade has announced that Tech Talks will return to the expo floor at the Feb. 18-20 event at the Kay Bailey Hutchinson Convention Center in Dallas. Tech Talks will feature 30-minute live interactive presentations to provide attendees with a comprehensive overview of various tech solutions. “These presentations are outside of the educational session tracks,” explains Chris Kinard, COO of Valere Health, the exclusive sponsor of Tech Talks. “We were once again able to carve out space on the expo floor with seating for about 50 people. We are going through the list of exhibitors and extending invitations for technology vendors to come and participate.” Topics at Tech Talks will include enterprise resource planning, RCM – AR, patient collections, patient management, sleep tech, prescribing, inventory management and document management. As of mid-November, the following companies have signed on to participate: Deroyal Industries, Tennr, Parachute Health, Notable Systems, Celeritas, Brightree, Mask Fit AR, Valere Health, Boostlingo and Synthpop. A limited number of additional slots are available. Those interested should email Erik Falter at erin.falter@emeraldx.com. 

Gayle Devin named chair of AAH council 

WASHINGTON – Gayle Devin, CEO of Home Care Delivered, is the new chair of AAHomecare’s Corporate Partner Provider Council, the association has announced. Devin brings to the role more than 25 years of experience in strengthening and growing medical service companies, including CEO roles at both ActivStyle and Pinnacle Medical Solutions. “I am very excited to lead the council and provide a framework for CEOs to help shape AAHomecare’s strategic priorities and ensure that they meet the concerns and needs of the HME community,” she said. “I really value the great networking opportunities and forum for company leaders to share ideas that the CPPC provides.” Devin previously served on AAHomecare's Medical Supply Council, where she played a leading part in growing the council and expanding the scope of its work, the association says. She was also instrumental in the development of the Incontinence White Paper released in 2020, it says. As CPPC chair, Devin will also be part of AAHomecare’s Executive Council. Gary Sheehan, general manager and senior vice president of diabetes for AdaptHealth, now moves into the vice chair role. 

NCPA applauds judge’s ruling in CVS case 

ALEXANDRIA, Va. – The National Community Pharmacists Association applauds a decision by a federal judge in Arizona in a class action case against CVS that a court, not an arbitrator, should decide whether a plaintiff’s claims against the company must be sent to arbitration.  Judge John J. Tuchi of the U.S. District Court for the District of Arizona agreed with Osterhaus Pharmacy that a provision in its contract with CVS that all disputes must be decided by an arbitrator is unconscionable, according to the NCPA. “Caremark and the other PBMs stack the decks in their arbitration proceedings to avoid accountability for illegal acts,” said Matthew Seiler, general counsel for the NCPA. “The ‘day in court’ they offer pharmacies costs more and takes away important rights that pharmacies would have if they could proceed in court. We are glad that the court recognized how Caremark’s forced arbitration clause is ‘substantively unconscionable.’ The arbitration process also keeps these cases secret. That allows Caremark and the other PBMs to continue to treat pharmacies unfairly and illegally extract junk fees. We are hoping this lawsuit helps to bring these unlawful practices into public view.” Matt Osterhaus, an NCPA member, filed his case against CVS in September of last year. At issue, the association says, is whether billions of dollars in backdoor fees that CVS imposes on pharmacies, otherwise known as DIR fees, are legal. As part of that case, Osterhaus challenged the legality of delegation clause. Other aspects of the case have yet to be decided, the NCPA says.