Attorney Mike Silverman of the Florida Healthcare Law Firm will be co-hosting with Board of Certification Credentialing Director Matt Gruskin for a special presentation exclusively focused on the the topic of adding durable medical equipment (DME) to a chiropractic office. As attendees may know, adding DME is a great way to impact a supplier’s revenue, but most importantly is a fantastic mechanism to provide more complete patient care and satisfaction.
During this “lunch n’ learn” Mike & Matt will break down the steps necessary for a chiropractic office to provide DME to its customers, be it cash paying, commercially insured, or Medicare patients alike.
Attorney Mike Silverman of the Florida Healthcare Law Firm will be co-hosting with Board of Certification Credentialing Director Matt Gruskin for a special presentation exclusively focused on the the topic of adding durable medical equipment (DME) to a chiropractic office. As attendees may know, adding DME is a great way to impact a supplier’s revenue, but most importantly is a fantastic mechanism to provide more complete patient care and satisfaction.
During this “lunch n’ learn” Mike & Matt will break down the steps necessary for a chiropractic office to provide DME to its customers, be it cash paying, commercially insured, or Medicare patients alike.
The indictments and regulatory activities that took place on April 9th were just the tip of the iceberg when it comes to the crackdown on DME fraud, telemarketing and telemedicine operations.
In the weeks and months that have followed ‘Operation Brace Yourself’, healthcare providers (such as DME suppliers and telehealth physicians) and telemarketers allegedly involved in these activities have been subjected to a wide range of penalties from suspension of Medicare billing privileges to civil penalties and/or criminal charges. Here are some of the more serious recent DME, telemarketing and telemedicine related civil and criminal regulatory enforcement actions:
Via justice.gov – One of the largest health care fraud schemes investigated by the FBI and the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) and prosecuted by the Department of Justice resulted in charges against 24 defendants, including the CEOs, COOs and others associated with five telemedicine companies, the owners of dozens of durable medical equipment (DME) companies and three licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $1.2 billion in loss, as well as the execution of over 80 search warrants in 17 federal districts. In addition, the Center for Medicare Services, Center for Program Integrity (CMS/CPI) announced today that it took adverse administrative action against 130 DME companies that had submitted over $1.7 billion in claims and were paid over $900 million. Read on…
Not tomorrow, but relatively soon. And with a vengeance! We knew the current Competitive Bidding Program moratorium wouldn’t last forever, and that the floodgates that opened as of the first of this year would eventually be reined in.
Indeed, on March 7, 2019 the Centers for Medicare and Medicaid Services (“CMS”) announced a new round of Competitive Bidding, which will commence on January 1, 2021 and last through December 31, 2023.
The largest changes from previous rounds of Competitive Bidding that immediately stand out are:
There are perfectly compliant ways to engage with healthcare marketers, and then there’s this; here are some of the latest real-life examples:
“DME BRACE CAMPAIGN – $40 to $150 PER LEAD PER BRACE”
“DME DIABETIC LEADS $40 PER LEAD, INSURANCE AND DOC INFO INCLUDED”
“PAIN CREAM/LIDOCANE LEADS FOR SALE, RX INCLUDED”
These marketers are seemingly holding auctions for the sale of federally protected patient health information out to the highest bidder! Couldn’t make this stuff up – if you’re in this industry, a quick gander at your (business) social media platforms will quickly confirm it.
Regulatory compliance is a mandatory investment for any healthcare business owner looking to stay out of serious and personal legal peril, let alone one hoping to keep their company viable.
Yet there is seemingly an onslaught of providers that blatantly run afoul of many of these regulations, knowingly or not, or those that believe they may have found a loophole.
Concerning the latter, there is an important mantra that such DME and pharmacy providers should remember and live by: “[W]hat a provider cannot do directly, it cannot do indirectly through an intermediary.”
Marketing for DME – What exactly am I talking about?
DME providers enrolled with CMS (should) know they cannot solicit or ‘cold call’ Medicare Part B beneficiaries, per the Federal Anti-Solicitation Statute, and that they cannot offer anything of value to a potential patient that could induce them to utilize them as a provider, in accordance with the Beneficiary Inducement Statute.
In CMS’ latest “MLN Connects” newsletter, the agency discusses the Comprehensive Error Rate Testing (CERT) program and the top five documentation errors committed by providers. Providers should pay close attention when CMS releases these types of notices. If selected for CERT review, providers are subject to potential action such as post-payment denials, payment adjustments, or other actions depending on the results of the review. Therefore, providers should ensure they fully understand Medicare’s documentation requirements and how to meet these demands.
Attorney Susan St. John of the Florida Healthcare Law Firm will present this live lunch n’ learn webinar to provide a legal look at durable medical equipment (DME) operation in Florida. She will discuss the requirements for operating a licensed DME in Florida that participates in the Medicare program, commercial insurance, telemedicine/telehealth, and drop ships products.
Physician owned distributorships (PODs) have been the source of considerable controversy for years. A couple years ago, they caught the attention of Congress. Now, the Office of Inspector General of the Department of Health and Human Services (“OIG”) has issued a Fraud Alert making clear their dislike of PODs and sending a clear shot across the bow of those who are in that industry.
PODs distribute various things, most commonly surgical implants and devices, that are reimbursed by insurers. A patient needs a spinal rod, a surgical implant/device company makes it and a distributor rep distributes it. Device/implant companies usually contract with distributorships to sell their products. Distributorships contract with reps who are paid commissions for sales. Surgeons who actually order the devices sometimes think “Since I’m the one doing the surgery and ordering all this stuff, why can’t I earn something from that? I’m not ordering anything I don’t need or that I don’t think is good for the patient.” PODs are one way for physicians to financially benefit from the sales of devices and items their patients need, but they have never been more controversial than now.
Health law is the federal, state, and local law, rules, regulations and other jurisprudence among providers, payers and vendors to the healthcare industry and its patient and delivery of health care services; all with an emphasis on operations, regulatory and transactional legal issues.
Attorney Mike Silverman of the Florida Healthcare Law Firm will be co-hosting with Board of Certification Credentialing Director Matt Gruskin for a special presentation exclusively focused on the the topic of adding durable medical equipment (DME) to a chiropractic office. As attendees may know, adding DME is a great way to impact a supplier’s revenue, but most importantly is a fantastic mechanism to provide more complete patient care and satisfaction.
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