Viemed pushes back on OIG’s findings

LAFAYETTE, La. – Viemed Healthcare says a recent report from the Office of Inspector General shows how disconnected investigators are from CMS’s clinical protocols for non-invasive ventilators and shines a light on the lack of understanding of the critical role HME providers play in providing this life-saving care to patients. 

The OIG in May published a report saying most of the Medicare claims submitted for the monthly rental of NIV by Viemed, under its original name Sleep Management, did not comply with Medicare requirements, resulting in overpayments of at least $29.1 million. 

“Viemed completely disagrees with the report’s findings and does not expect to receive an overpayment determination from CMS,” said Casey Hoyt, Viemed Healthcare’s CEO. “We expect CMS to disregard the recommendations contained in the report, as they contradict prescribing physicians’ and CMS’s own research-based guidance for the DME industry.”  

The OIG found that, of the 100 sampled claim lines with payments totaling $75,694, two complied with Medicare requirements and 98 did not. 

The agency recommends that Sleep Management refund the portion of the estimated $29.1 million in Medicare overpayments for claim lines incorrectly billed that are within the four-year reopening period; exercise reasonable diligence to identify, report and return any similar overpayments in accordance with the 60-day rule; and follow existing policies and procedures to help ensure that it complies with Medicare requirements. 

Viemed, however, published a response to the report making the following points: 

• The lack of clear guidance on the use of NIV for COPD means that different government entities apply differing, and often conflicting, standards on when NIV is appropriate. This is confusing for physicians, patients and suppliers, and leads to non-medical bodies like the OIG substituting their alleged medical judgment for that of treating physicians. 
• Of the 100 claims audited by OIG, 42 claims were previously audited by CMS during a separate review. As a result of that previous audit, CMS approved and paid 41 of the 42 claims. OIG subsequently failed all 42 of the claims. The report does not address this glaring inconsistency. 
• As part of their treatment plan, 89 independent physicians around the country wrote NIV prescriptions and supplied medical records supporting that decision in a good faith effort to provide NIV for the 100 seriously ill patients with chronic respiratory failure who were the subject of this audit. These treating physicians believed NIV was in the best interest of their patients, but the OIG medical review contractor, Maximus, which had no contact with patients except to briefly review their charts years later, contradicted their physicians’ medical conclusions as to what was best for them. 
• The OIG audit plan instructed Maximus reviewers to “explain why the medical records did not justify treatment with a NHV,” showing that OIG’s intent was to subjectively find ways to deny coverage to these seriously ill patients. 
• Applying OIG’s guidance that NIV is essentially never warranted would deny coverage for life-extending therapy from an estimated 75,000 patients across the country. This would actually increase the cost to CMS by requiring patients to use repeat visits to the emergency room to manage their diagnosed and documented end-of-life conditions. 

The OIG says it reviewed Sleep Management’s comments but maintains its findings and recommendations are valid. To avoid potential confusion, it did remove a finding related to a beneficiary’s continued need for NIV, but removing this finding did not change its estimated overpayments or recommendations, it says.