The group supplied the following address for filing a complaint: www.sba.gov/idc/groups/public/documents/sba_program_office/ombud_sba1993.pdf.

Kennedy Groups to Tackle Health Care Reform
WASHINGTON--In a strategic move to have a strong voice in health care reform in Congress, Sen. Ted Kennedy, D-Mass., announced last week he has created three committee work groups to forge legislation that would reform the nation’s fractured health care system.

Kennedy, chair of the Senate Health, Education, Labor and Pensions Committee, has been battling a malignant brain tumor and has not been on the Senate floor since July, when he came to cast his vote in favor of the Medicare bill that included the delay of the competitive bidding. He returned to the Senate last Monday, where he announced his three-pronged effort to come up with a comprehensive health care plan.

Sen. Tom Harkin, D-Iowa, will lead a group on prevention and public health, while Sen. Barbara Mikulski, D-Md., will spearhead a group focusing on quality improvement. Sen. Hillary Rodham Clinton, D-N.Y., is to lead a group on insurance coverage. (At press time, Clinton was reportedly mulling a position as Secretary of State in President-elect Barack Obama’s cabinet).

Kennedy’s announcement comes on the heels of a comprehensive health care plan revealed Nov. 12 by Sen. Max Baucus, D-Mont., chair of the Senate Finance Committee. And the day after Kennedy announced his panel, Harkin released his own ideas on how best to improve health care, prompting political observers to muse that several Democrats were jockeying for the position of “lead health care reformer.”

Kennedy and Baucus, along with ranking minority leaders, were to meet Friday to determine how best to advance health care form in the new Congress.

The ailing senator, who has long championed comprehensive health care, was optimistic that a health care package can be hammered out early next year.

“I will continue to lay the groundwork for early action by Congress on health reform when President Obama takes office in January,” said Kennedy. “We’re making real progress in our discussions about a consensus approach, and I’m optimistic we’ll succeed.”

Value of Family Caregiving Hits $375 Billion
WASHINGTON--The economic value of family caregiving in the United States reached $375 billion in 2007--exceeding the $311 billion spent for Medicaid last year--according to a new report by AARP's Public Policy Institute. The new estimate reflects an increase in the U.S. population, the aging of the population and a higher estimate of the average value for one hour of care, AARP said.

The report, "Valuing the Invaluable, The Economic Value of Family Caregiving, 2008 Update,” estimates that 34 million Americans provide more than 20 hours of care per week to another adult.

"Family caregivers are a vital and largely unrecognized part of America's health and long-term care system,” said AARP Policy Director John Rother, noting that family caregiving has been shown to reduce hospital readmissions and delay entry into nursing homes. "We often overlook how much family and friends contribute--whether it's picking up groceries each week or providing daily health care for their loved ones.”

The report notes that informal caregivers of people 50-plus spent an average of $5,531 out-of-pocket in 2007 to care for their loved ones. That spending is often coupled with lost workdays, wages, health insurance and retirement savings. More than one-third of informal caregivers are forced to quit their jobs or reduce their working hours, with women more likely to leave the labor force entirely. Caregivers also frequently struggle with health care bills and medical debt and experience chronic stress. Even less noticed is the physical, financial and emotional toll caregiving can take, Rother added.

The report makes several recommendations to assist caregivers, including adopting family-friendly workplace policies; providing caregivers with needed supports; expanding funding for the National Family Caregiver Support Program and the Lifespan Respite CareAct; and supporting family caregivers in chronic care coordination programs and care transitions.

"Family caregivers are likely to be stretched even further in today's tumultuous economy. Now is the time to ensure caregivers have the support they need. Everyone--business, government and individuals--can do more to give back to those who give so much,” concluded Rother.

The full report is available by clicking here.

South Florida Fraud Cases Just Keep On Coming
MIAMI--The owner of 13 South Florida DME companies and three clinics pleaded guilty to criminal charges in connection with a Medicare scheme involving nearly $57 million in false claims, federal prosecutors announced Nov. 14.

According to a statement from R. Alexander Acosta, U.S. attorney for the Southern District of Florida, defendant Miguel Almanza and his co-conspirators concealed their control of the DME companies and clinics, located in Miami-Dade and Hillsborough counties, by recruiting "nominee" or "straw owners," who were typically paid a percentage of the fraud proceeds to sign the necessary corporate records and Medicare applications.

“Notably, Almanza often recruited family members or recent immigrants from his hometown of Moron, Cuba, to serve as the nominee owners of his DME companies,” the statement said.

The companies submitted $56.7 million in false claims for medical equipment including nebulizers, oxygen concentrators, powered air mattresses and wheelchairs.

In the scheme, Almanza purchased the identities of beneficiaries and used their Medicare numbers to submit the claims. During the early years of the conspiracy, Almanza and his partners paid monthly cash kickbacks to these "professional patients” so they would not report the false claims to Medicare, according to the statement.

But over time, “the scheme changed because Almanza and his partners found it cumbersome to pay kickbacks to dozens of patients. Consequently, Almanza and his partners began to purchase stolen patient identities from patient recruiters and billing companies.”

Once Medicare paid the false claims, some proceeds were laundered by distributing pre-signed corporate checks, often for amounts just under $10,000, to a network of so-called "check cashers," who were paid a typical 10 percent commission to cash the checks at local banks.

Under a second laundering scheme, nominee owners were recruited to open various sham corporations, including construction companies and investment firms. The Medicare proceeds were deposited into those companies’ bank accounts and then later distributed to Almanza and his partners, the statement said, adding: “Almanza used the fraud proceeds to purchase a home, luxury cars and to finance other lavish personal expenditures. Almanza also used the funds for gambling at various South Florida casinos, where he often spent more than $10,000 per night.”

Almanza faces a maximum 10-year prison term for the Medicare conspiracy, and five years for making false claims upon the United States.

For a list of the DME companies involved, click here.

The scheme follows another $17 million South Florida fraud case that kept things all in the family.

According to a statement from Acosta, defendants David Hernandez and his wife Laura Hernandez of Pembroke Pines, Fla., began defrauding Medicare as early as 1999 when they opened two DME companies, Florida DME and On-Time Medical Equipment Rentals, and used them to submit $5.9 million of false claims. Laura Hernandez then formed Triple AAA Billing, which processed and submitted the companies’ electronic claims.

In 2003, David Hernandez expanded the scheme when he opened SOS DME with co-defendant Magaly Martinez, the receptionist at On-Time Medical. Later, Hernandez opened additional DME companies with three of Martinez’ family members, including YYS Medical Supply with Martinez’ son, defendant Yuniel Echevarria; All County Medical Equipment with Martinez’ husband, defendant Jose Echevarria; and Tri-County Medical Supplies with Martinez’ daughter-in-law, defendant Suyima Torres. These four DMEs submitted another $11.3 million in false Medicare claims that were processed by Laura Hernandez’ company, Triple AAA Billing.

David Hernandez’ brother, defendant Jose Miguel Hernandez, helped to promote the scheme and conceal the false claims by delivering kickbacks “to a vast network of ‘professional patients’ who were paid to sell their Medicare cards,” the statement said. “When Jose Miguel Hernandez visited each patient’s home, he would instruct them to sign ‘delivery receipts,’ which created the appearance that the patients had received durable medical equipment. In fact, howver, the patients did not receive any equipment. After the patients signed the necessary forms, Hernandez would pay them cash, often $200 to $300 per visit.”

David Hernandez, Laura Hernandez, and Jose Miguel Hernandez face a maximum of 10 years in prison on the Medicare fraud offenses.

In separate cases in July, co-conspirators Magaly Martinez, Jose Echevarria, Yuniel Echevarria and Suyima Torres pled guilty to Informations charging them each with one count of conspiracy to commit health care fraud.

Newsmakers
New Sales Directors at Diabco, Mada Medical
Delray Beach, Fla.-based DIABCO Healthware Software Solutions has appointed Virginia Greenwood as its new national sales manager. Greenwood brings 12 years of experience in sales and is also an expert in consulting and management services.

Jeffrey Cloidt, D.D.S., has joined Mada Medical Products, Carlstadt, N.J., as medical director of sales and marketing. Cloidt will focus on the growth and development of Mada's business in infection control products, as well as its needle-free MadaJet product line. He earned his D.D.S. degree from the Columbia University School of Dentistry, and served on the faculty of both the Columbia and Harvard Schools of Dentistry.

Ann Keeling has joined The International Diabetes Federation, Brussels, Belgium, as CEO and executive director. IDF is an umbrella organization of more than 200 diabetes associations worldwide, and a global advocate for the more than 250 million people with diabetes, their families and health care providers. Keeling, joining at a time when the diabetes pandemic is straining global health care resources, will help steer the response of the IDF as it broadens efforts to increase awareness of the disease and encourage action.

In Brief
Providers Await NSC Standards; CMS Issues MLN Article on 2009 Fee Schedule
The word from Erika Williams, ombudsman for the National Supplier Clearinghouse, is that the final rule on provider standards could contain six to 10 more standards when it is issued. When will that be? No one knows, Williams said at last month’s Medtrade.

CMS has released an MLN Matters article (MM6270) on the 2009 Fee Schedule Update for DMEPOS, including a 9.5 percent reduction for items included in Round One of the competitive bidding program--with the exception of HCPCS codes E1392, K0738, E0441, E0442, E0443 and E0444. These six oxygen generating portable equipment (OGPE) and oxygen contents codes will not be affected by the 9.5 percent cut, CMS explains. Non-competitive bid items will receive a 5 percent covered item update for 2009. To view the article, click here.

The rate of patients discharged from hospitals who still needed home health care increased 53 percent (from 2 million to 4 million) between 1997 and 2006. According to the Agency for Healthcare Research and Quality, there was a 30 percent increase (from 4 million to 5 million) in the rate of patients discharged to nursing homes or rehab facilities during the same period. The increases reflect the rising number of hospital patients who are acutely ill or cannot take care of themselves after being discharged, AHRQ said. Overall, hospital discharges for all conditions rose from roughly 35 million to 40 million--a 14 percent increase.

Think your knowledge of Medicare guidelines is pretty solid? You can test it out by taking a quiz on DME MAC Jurisdiction A’s Web site, www.medicarenhic.com/dme/dme_quiz_form.shtml. Officials assure providers that the quizzes are not a way of determining if they are going to do an audit; they’re simply designed for education.

The average daily rate for a private room in a nursing home remained essentially unchanged from 2007 at $212, while semi-private rates increased $2 to $191 this year, or $69,715 annually, according to a MetLife Market survey of 2008 nursing home costs. The national average daily rate for a private room in an Alzheimer’s unit is $219 ($79,935 annually) and $198 ($72,270 annually) for a semi-private room. The highest daily rates for nursing homes are in Alaska, at $577 for a private room and $566 for a semi-private room. The lowest are in some areas of Louisiana, where a private room averages $127 per day.

According to the American Geriatrics Society, a shortage of geriatricians could reach crisis proportions as millions of baby boomers age. By 2030, when the last of the baby boomers reaches the age of 65, the U.S. population aged 65 and older will exceed 70 million, roughly twice the number in 2000. This year life expectancy reached 78, a national record high, setting the stage for more seniors than ever and fewer physicians to care for them. There are currently 4.7 geriatricians for every 10,000 older adults in the United States, but AGS said the government predicts by 2050, there will be 1.6 geriatricians for every 20,000 older adults.

The World Health Organization is hoping new wheelchair guidelines will promote mobility and independence for people with disabilities in “less-resourced” settings. The guidelines address the design, production, supply and service delivery of manual wheelchairs, in particular for long-term wheelchair users. According to WHO, the wheelchair is one of the most commonly used assistive devices for enhancing the personal mobility of people with disabilities. An estimated 1 percent of the world’s population, or just over 65 million people, need a wheelchair. In most developing countries, WHO said, few of those who need wheelchairs have access, production facilities are insufficient and wheelchairs are often donated without the necessary related services.

In 2007, diabetes cost the United States $218 billion due to higher medical expenditures and lost productivity, according to a report released Tuesday by Danish pharmaceutical company Novo Nordisk, which manufactures insulin and diabetes medications. Conducted by The Lewin Group, the research shows that beyond the estimated $174 billion widely accepted as the cost of diagnosed diabetes in 2007, an additional $18 billion was spent on 6.3 million people with undiagnosed diabetes; $25 billion for 57 million American adults with pre-diabetes; and $623 million for 180,000 pregnancies where gestational diabetes was diagnosed. “In individuals with pre-diabetes, we observed a significant increase in ambulatory visits for a wide variety of medical conditions, including hypertension, endocrine, metabolic and kidney complications,” said Tim Dall, vice president at The Lewin Group. “Additionally, the data show that during the two years before diagnosis people exhibit an increase in ambulatory and hospital-based care for diabetes-related complications.”

What’s in an image? If it is DME, it’s bad news, according to Steven T. Behm of the Edelman Company, a public relations firm that has studied the industry. Since the beginning of the year, 800 stories, most about fraud and abuse in the industry, have appeared across the country, three times as many as last year, Behm said last month at Medtrade.

In a move expanding its partnerships with health plans, The Scooter Store recently announced agreements with 17 insurance companies to provide power wheelchairs and scooters to nearly 7 million people. To date, the New Branufels, Texas-based provider has more than 125 partnerships with health plans that cover in excess of 160 million people. Some of the company’s new contracts, which include Medicare Advantage plans and Medicaid programs, now offer power wheelchairs and scooters to 3,900,000 health plan members in Ohio, 600,000 in Northeastern Pennsylvania, 700,000 in Washington, 565,000 in Michigan and 340,000 in New York. Other contracts provide coverage for an additional 475,000 members in states such as New Mexico, Oklahoma, Minnesota and Texas.

Last week, CMS reported its 2007 national composite error rates for Medicaid and the State Children’s Health Insurance Program. The agency reported $32.7 billion in improper Medicaid payments for FY 2007, or about 10.5 percent of all Medicaid payments, with an $18.6 billion federal share. For SCHIP, the rate is 14.7 percent, or $1.2 billion, with a federal share of $800 million. CMS said the vast majority of Medicaid and SCHIP errors are due to inadequate documentation; providers either did not submit information to support their claims or did not submit additional data when requested. Other errors are due to services provided to beneficiaries who were not eligible for either program or who were not eligible for the services rendered. Due to “aggressive efforts to reduce payment errors,” CMS also said the Medicare fee-for-service rate has declined from about 14 percent in 1996 to the 2008 rate of 3.6 percent.

Coming Up
On the HME Calendar
The American Association for Respiratory Care (AARC) will hold its 54th International Respiratory Congress in Anaheim, Calif., Dec. 13-16. For information, call 972/243-2272 or visit www.aarc.org.

The Alabama Durable Medical Equipment Association (ADMEA) will hold its Annual Meeting in Montgomery, Ala., Jan. 7. For information, call 205/824-6202 or visit www.admea.net.

The Big Sky Association of Medical Equipment Services will hold its Quarterly Meeting in Butte, Mont., Jan. 9. For information, call 406/777-7301 or visit www.bigskyames.org.

The North Carolina Association for Medical Equipment Services (NCAMES) will hold its Winter Meeting in Raleigh, N.C., Jan. 28-29. For information, call 919/387-1221 or visit www.ncames.org.

The Assistive Technology Industry Association (ATIA) will hold its Annual Conference in Orlando, Fla., Jan. 28-31. For information, call 877/687-2842 or visit www.atia.org.

To revisit this news any time during the week, go to www.homecaremonday.com.