QIC sides with Viemed

LAFAYETTE, La. – Medicare’s Qualified Independent Contractor found that 77% of certain claims for non-invasive ventilation submitted by Viemed Healthcare were, indeed, medically necessary. 

The Office of Inspector General in May 2021 issued a report saying most of the Medicare claims submitted for non-invasive ventilation by the company under its original name, Sleep Management, did not comply with Medicare requirements, something the company pushed back on. 

“The success of our latest round of appeals is an extremely positive development for patients and their families who depend on payers to hold up their end of the health care delivery network,” said Casey Hoyt, Viemed’s CEO. “We wholeheartedly believe in protecting and advancing the rights of these patients to have access to the care prescribed by qualified licensed physicians. As a leader in the respiratory care industry, we will continue to support responsible rulemaking and other initiatives to ensure that the best care remains available to those in need.”  

In its report, the OIG alleged that 98% of sampled claims in an audit of Sleep Management’s non-invasive ventilation patients did not comply with Medicare requirements and recommended that CMS recoup funds. Through the statutory appeals process, the company filed its reconsideration appeals to the QIC in November 2021, seeking an objective and independent review of the OIG’s and CMS’s findings.  

Because the initial overpayment determinations used the OIG’s statistical extrapolation based on a 98% failure rate, the QIC’s decisions stated that any remaining overpayment amounts will need to be recalculated. While the results of the latest appeals significantly reduce the range of possible losses, Viemed awaits communication of recalculated overpayment amounts, which may require further appeals.