Provider Falls through Policy Black Hole with Customer

Bellingham, Wash.

The customer isn’t always right.

At least that’s the message Tim Johnson, president of Global-Med Specialty Medical Equipment, said he would like to convey. The provider has dealt with a “problem customer” who he said has requested a string of unnecessary service visits and has abused his company’s rental equipment.

After talking with legal counsel, CMS and DMERC representatives, Johnson said he found that, technically, “a Medicare Participating Provider cannot, under any circumstances, terminate an account for a capped rental item once that rental has moved into the maintenance and servicing period, as long as there remains a medical necessity.”

In a Nov. 5 letter, Malvin White of CMS’ Seattle branch office told Johnson that “Medicare rules do not provide clear guidance on a supplier’s rights in cases where a beneficiary abuses equipment.”

With an attorney’s help, Johnson said, he hopes to end the problem rental agreement soon. “It’s like a Black hole,” Johnson said. “I think other suppliers would be very concerned to learn that there is no way out once an account goes into the maintenance and servicing period.”