Home Health & Hospice Week

Rates change from original projections. Respiratory drug suppliers received some mixed news with the release of the average sales price-based payment rates for 2005.
 
The rate for a unit dose of albuterol sulfate (J7613) rose from the $0.04 proposed in the 2005 physician fee schedule to $0.07, according to a list of the prices on the Centers for Medicare & Medicaid Services' Web site. The change occurred based on the latest data drug manufacturers provided to CMS.
 
But ipratropium bromide's rate (J7644) decreased slightly from the proposed $0.30 to $0.29, according to CMS.
 
The new rates, which represent a nearly 90 percent cut, will be offset by the newly increased $57 dispensing fee per month or $80 fee per 90 days (see Eli's HCW, Vol. XIII, No. 41, p. 323). Those figures are up from the former $5 per month.
 
The latest Medicare drug prices are online at www.cms.hhs.gov/providers/drugs/asp.asp.   You must register by Feb. 18 if you wish to attend the next meeting of the competitive bidding Program Advisory and Oversight Committee. The PAOC will convene in Baltimore Feb. 28 through March 2, CMS says.
 
The public may comment "if time permits," CMS says. More information is at www.cms.hhs.gov/ suppliers/dmepos/compbid/paoc.asp#meeting.   Despite a slew of new responsibilities under the Medicare Modernization Act, the HHS Office of Inspector General says it is confident its enforcement duties will not be compromised.
 
According to the OIG's latest semiannual report, the agency recouped almost $30 billion through recommendations, investigative efforts and audit recoveries. More than 3,000 entities and individuals were excluded from federal health care programs. This number includes more than 500 convictions and 268 civil actions.
 
However, in a message preceding the report, acting IG Daniel Levinson concedes the agency may become cash strapped. "With funding ... statutorily capped at the fiscal year 2003 spending level, balancing the work this office traditionally has done with new oversight responsibilities posed by the MMA presents a unique challenge," Levinson said.
  Sometimes a business lives up to its name. Oxygen supplier John Shaw, owner/operator of Paintsville, KY-based Med Con, must pay the piper for allegedly funneling more than $73,000 in kickbacks to a local physician, according to Gregory F. Van Tatenhove, U.S. Attorney for the Eastern District of Kentucky.
 
In September 2004, Shaw pled guilty to 10 counts of making kickbacks to an unnamed Martin, KY-based doctor and two of his associates, Tatenhove says in a release. The funds were in return for the doc falsifying patients' oxygen test results and referring the patients to Med Con, prosecutors claim.
 
Shaw, who is in seriously failing health, was sentenced to six months' home confinement and ordered to pay $354,000 in restitution to Medicare.   More charges are stacking up against wheelchair fraudsters in [...]