Law School

The Medicare anti-kickback statute states that a health care provider (such as a DME supplier) cannot provide anything of value to a person or entity in exchange for referring, or arranging for the... Read more >
An increasing number of commercial insurers are closing their provider panels—not allowing the suppliers to bill the insurers as in-network suppliers. This relegates the out-of-network suppliers to:... Read more >
It is important that the supplier stay off the slopes that result in an enforcement action by a governmental agency. One of these slippery slopes pertains to waiving co-payments. While it is... Read more >
It is clear that CMS does not like DME suppliers calling Medicare beneficiaries. The concern is that an elderly person who does not feel well can be easily taken advantage of over the phone by an... Read more >
There is a perfect storm of events that is pushing HME suppliers into the retail market. First, Medicare is broke. Second, there are 78 million Baby Boomers who are accustomed to paying their own way... Read more >
Assume that despite its best efforts, an HME provider is not awarded a competitive bid contract. This may be a blessing in disguise, presenting the following potential opportunities: Expanding... Read more >
Assume that a DME supplier purchases the assets of another DME supplier. In addition to transferring its “hard” assets to the purchaser, the seller will transfer its “intangible... Read more >
The HME industry is a young industry. In its present form, it has been around for about 30 years. The industry grew up relatively unregulated. The Centers for Medicare & Medicaid Services (CMS... Read more >
There are a number of federal statutes and regulations that govern HME providers. The “big four” are the: 1) Medicare anti-kickback statute; 2) telephone solicitation statute; 3)... Read more >
It is the “irresistible force” meeting the “immovable object.” The “irresistible force” is the 78 million-strong Baby Boomer Generation—born between 1946... Read more >
Editor's note: A condensed version of this article appears in the January 2012 edition of HomeCare magazine. Let us look at the worst case scenario. Despite diligent efforts to bid in one or... Read more >
This is the third of a 4-part series on the provisions of the Patient Protection and Affordable Care Act (PPACA) and how the health reform law affects DME providers. Series: Part 1 | Part 2 | Part 3... Read more >
This is the second of a 4-part series on the provisions of the Patient Protection and Affordable Care Act (PPACA) and how the health reform law affects DME providers. Series: Part 1 | Part 2 | Part 3... Read more >
This is the second of a 4-part series on the provisions of the Patient Protection and Affordable Care Act (PPACA) and how the health reform law affects DME providers. Series: Part 1 | Part 2 | Part 3... Read more >
Pre-payment reviews and post-payment audits have increased in frequency and intensity. With a post-payment audit, at least payment has been received up front, allowing an HME company to keep its... Read more >