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23 Jan 2017, 8:56 am
Durable Medical Equipment: A North Carolina owner of a DME supplier was ordered to pay $2.6 million in restitution (and sentenced to 3.5 years) in connection with an alleged Medicare fraud scheme involving sham DME companies and purchased lists of individually identifying health information, which were then used to submit false claims. [read post]
6 Jan 2017, 5:57 am
While it is true the company makes these products, the firm’s real profits come from the fact that it is a major pharmaceutical manufacturer as well as major maker of medical devices and durable medical equipment (DME), such as artificial hips and knee implants. [read post]
20 Dec 2016, 6:38 am
As previously reported, CMS finalized regulations to require Medicare PA for certain durable medical equipment (DME), prosthetics, orthotics, and supplies (DMEPOS) items that the agency characterizes as “frequently subject to unnecessary utilization. [read post]
20 Dec 2016, 6:33 am
” On the other hand, four out of five beneficiary advocacy groups interviewed reported that their members experienced access issues related to competitive bidding (e.g., delays in delivery of CBP-covered DME items and trouble locating contract suppliers to provide specific DME items). [read post]
6 Dec 2016, 4:20 pm
CMS has announced 2017 Medicare fee schedule rates for durable medical equipment (DME) prosthetic orthotics and supplies (DMEPOS) furnished in non-competitive bidding areas. [read post]
26 Sep 2016, 8:18 am
Following another Defense Medical Examination (DME, laughingly referred to officially as an “Independent” Medical Examination, where nothing is independent) with the same expert as in the prior litigation, the workers’ compensation insurance carrier filed another Petition for Termination in 2010. [read post]
26 Sep 2016, 8:18 am
Following another Defense Medical Examination (DME, laughingly referred to officially as an “Independent” Medical Examination, where nothing is independent) with the same expert as in the prior litigation, the workers’ compensation insurance carrier filed another Petition for Termination in 2010. [read post]
13 Sep 2016, 5:20 am
The OIG recommends that CMS seek a legislative change to base payments for DME infusion drugs on ASP; alternatively, CMS could use its existing authority to include DME infusion drugs in the competitive bidding program. [read post]
8 Sep 2016, 5:38 am
CMS has identified errors in its July 2016 update to Medicare durable medical equipment (DME) prosthetic orthotics and supplies (DMEPOS) fee schedule amounts for certain items in non-competitive bidding areas. [read post]
8 Aug 2016, 11:57 am
On the plaintiffs’ side, we prefer to call these examinations “Defense Medical Examinations”, or “DME’S”, since there is really nothing “independent” about them. [read post]
1 Aug 2016, 9:21 am
The DME MACs point out that manufacturers and other entities do not have authority to assign their own code determinations to specific products. [read post]
4 Jul 2016, 8:31 am
CMS also requests comments on a series of issues related to timely access to DME benefits for individuals dually eligible for Medicare and Medicaid. [read post]
4 Jul 2016, 6:01 am
The way IME companies are seen as potential profit centers for private-equity firms is one of the many reasons that if an IME – Independent Medical Exam – or DME – Defense Medical Exam – is ordered for an injured worker, that injured worker should seek the advice of an experienced workers’ compensation lawyer. [read post]
28 Jun 2016, 1:11 pm
As previously reported, the Affordable Care Act mandates that CMS use pricing information from competitive bidding to adjust DME fee schedule amounts for items furnished in areas where the CBP is not implemented. [read post]
23 Jun 2016, 7:03 am
The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and prescription drugs. [read post]
22 Jun 2016, 10:57 am
The legislation would be financed by accelerating implementation of a Consolidated Appropriations Act of 2015 provision that limits state Medicaid DME reimbursement amounts to the Medicare fee-for-service payment rates, including applicable competitive bidding rates. [read post]
16 Jun 2016, 7:17 am
Respironics allegedly provided DME companies with call center services to meet their patients’ resupply needs at no charge as long as the patients were using masks that Respironics manufactured; otherwise, the DME companies would have to pay a monthly fee based on the number of patients who used masks manufactured by a competitor of Respironics. [read post]
1 Jun 2016, 10:25 am
It may have opened the doors to a flood of DME requests. [read post]
28 May 2016, 8:14 am
• Acute Care (physicians, CORF/ORF, HHA, DME, medical supplies, SHARS, MAC) • Resource-based Fees: equal to Medicare Relative Value Unit (RVU) for the service multiplied by applicable Medicaid conversion factor. [read post]
18 May 2016, 1:13 pm
Gibran Ameer, has been employed by different DME companies. [read post]
