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Home Health & Hospice Week

Industry Notes:

Final Rates For Inhalation Drugs Set

Published on Thu Jan 06, 2005

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 Texas. The feds have leveled additional fraud and money laundering claims against Aniekeme B. Akpabot, owner of Mina Medical Equipment and Supplies in Mesquite, TX; Okon Eyo Idiong, owner of OK Medical Equipment and Supplies in Southfield, MI; and Aniefiok Jimmy Eking, owner of Medical Equipment and Supplies and Mescorp Pharmaceuticals in Houston, TX.
     
    The new 43-count indictment adds to previous charges against Eking (see Eli's HCW, Vol. XII, No. 34, p. 267) and supersedes charges against Akpabot, who was indicted last February as part of "Operation Roll Over" (see Eli's HCW, Vol. XIII, No. 6, p. 47), says Richard B. Roper, U.S. Attorney for the Northern District of Texas.
     
    The indictment accuses the men in 2002 and 2003 of soliciting beneficiaries by paying recruiters to produce them, and then obtaining false certificates of medical necessity and wheelchair prescriptions in exchange for payments to participating physicians. The companies never delivered the equipment to beneficiaries or delivered far less expensive scooters, prosecutors say.
     
    Akpabot and Eking are fugitives while Idiong was arrested in Detroit and is in custody in Texas, Roper says in a release. The men face hundreds of years in jail time and millions in fines and restitution if convicted.

     

  • The long arm of Texas justice reaches all the way to Europe. After being arrested in Spain following an indictment for health care fraud, wife and husband Robbie Lesa Hames and Charles William Hames were convicted in Texas in March of numerous charges including health care fraud and money laundering.
     
    The owners of Irving, TX-based home health agency Alternate Care defrauded Medicare with inflated cost report expenses and used the funds to make lavish home improvements, prosecutors charged (see Eli's HCW, Vol. XIII, No. 12, p. 96).
     
    Last month Robbie Hames was sentenced to eight years in prison and Charles Hames was handed six years, according to the Dallas Business Journal. Co-conspirator James Michael Davis, who owned Irving staffing business Accelerated Home Health Personnel, was also sentenced to six years on similar charges.
     
    The defendants were ordered to pay about $3 million in restitution, says U.S. Attorney Richard B. Roper. The Hameses will forfeit real estate in Texas and another $410,000.

     

  • You now should be able to more easily identify the hospices that belong to long-term care giant Beverly Enterprises Inc. All the hospices Fort Smith, AR-based Beverly owns, including Lone Star Hospice in Round Rock, TX, have changed their name to AseraCare, reports the Austin Business Journal.

     

  • Akron, OH-based Cambridge Home Health Care has opened its 22nd office in the state. The new location is in Galion, says the agency that serves more than 2,000 patients a week with 1,425 employees.

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