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Home Health & Hospice Week

Industry Notes:

MISSED DEADLINE COSTS INFUSION PROVIDER $185,000

Published on Thu Mar 06, 2003

A deadline is a deadline, and infusion provider Caremark Therapeutic Services wasn't able to bypass one with an appeal to federal court.

Caremark missed the six-month deadline to appeal a decision by Part B carrier Noridian Mutual Insurance Company to disallow $185,000 in pharmacy and infusion services, says the U.S. District Court for the Southern District of New York in a Jan. 29 decision in Caremark v. Thompson (No. 01 Civ. 11316 (VM)). Caremark admitted that it missed the deadline and blamed it on a discharged employee.

When Noridian refused to reopen the decision, Caremark filed suit, charging that Noridian had violated Medicare due process and Administrative Procedure Act laws by refusing to review the case. Caremark also sought for the court to exert mandamus jurisdiction, used only in extraordinary situations.

The court shot down Caremark's claims, noting that the company simply missed its deadline to appeal and would have to face the consequences.

  • The HHS Office of Inspector General is hosting its third regional town hall meeting, this time for West Coast providers, April 11.

    The meetings aim to provide a forum for OIG senior staffers to meet face-to-face with the provider community. Regional meetings for other parts of the country will take place in the coming months.

    If you're in Region IX or X and are interested in attending, e-mail the following information to oigspeaks@oig.hhs.gov or fax it to 202-260-8512: name/title, organization, organization address, telephone number, e-mail address or fax number. Space is limited.

  • As of April 1, the DMERCs will accept K0552 instead of A4232 for supplies with external infusion pumps, according to program memo AB-03-031. The new code will include the medication trepostinil.

  • The aftermath of financier National Century Financial Enterprises' collapse has entered the back-stabbing phase. NCFE co-founder Rebecca Parrett filed suit last month against partner Lance Poulsen, charging him with orchestrating a "classic Ponzi scheme" where the company sold new bonds to pay off old investors, reports The Washington Post.

    By mid-1999, half of the company's receivables were worthless, says the suit that cites e-mails, internal memos and audit reports. Parrett claims she was kept out of the loop, according to the Post. Poulsen and the financial institutions named as co-defendants deny any wrong-doing.

    The suit says NCFE fraudulently advanced more than $400 million to a company Parrett, Poulsen and another partner owned, Homecare Concepts of America, even though it didn't provide required collateral and "had no ability to repay the money under any circumstances," says the Post. The suit seeks $50 million in damages.

    Meanwhile, Arizona's attorney general's office says it won't investigate the state treasurer's office for its $131 million investment in NCFE.

  • VistaCare Inc. has reported a net income to common shareholders of $2.5 million on revenues of $39 million for the quarter ended Dec. 31, compared to a net loss of $2.7 million on revenues of $25 million for the same period of 2001. The Scottsdale, AZ-based for-profit hospice chain's average daily census was 3,862 for the quarter.

    The company projects same-site revenue growth of 30 percent in 2003.

    Vista Care made its initial public offering on Dec. 23, 2002. The company's stock price dipped from $16.20 per share before the earnings announcement to $15 at press time.

  • Home Care Supply Inc. has acquired First Medical of Texas, with locations in Bryan and Navasota, says the Beaumont, TX-based DME company with 57 locations in 12 states.

  • A visit solely to perform a fingerstick blood sugar will not qualify as a skilled nursing visit because it doesn't require the skills of a nurse, regional home health intermediary Cahaba GBA says in its March 1 Newsline. However, if observation and assessment is ordered for the patient, evaluation of the blood sugar results may be covered, Cahaba says.

  • CMS has established a HCPCS code for electromagnetic stimulation, but Medicare won't cover the procedure, according to Feb. 29 program memorandum A-03-015. Starting April 1, regional home health intermediaries will automatically deny claim lines for the new code, E0761.

  • A new product called the Smart Capno-line Cannula can monitor how well a patient is absorbing oxygen by collecting the CO2 the patient breathes out, reports Design News. Chicago-based Herbst Lazar Bell worked with Israel's Oridion Medical to develop the device, which will help detect emergencies in patients receiving oxygen at home or in hospitals.

  • An Ohio legislative committee is stalling rules needed to launch a state program that will enable 3,000 mentally retarded and developmentally disabled people to receive care from their families at home. The federal government already has approved the program, which was supposed to launch this month, reports the Associated Press.

     

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