Issue link: https://read.dmtmag.com/i/52926
HME NEWS / FEBRUARY 2012 / WWW.HMENEWS.COM NORTH CAROLINA Diabetes contract: Winner? Roche. Loser? Beneficiaries BY THERESA FLAHERTY, Managing Editor RALEIGH, N.C. – North Carolina is sticking with a single manufac- turer for diabetes supplies, but it's switching manufacturers. On Nov. 14, state officials announced that Roche would take over the contract previously held by Charlotte-based Prodigy Dia- betes Care. The two-year deal is expected to save the state $6 mil- lion through rebates. The effective date: Nov. 15, 2011. "This could be worse than the prior contract," said Beth Bowen, executive director of the North Carolina Association of Medical Equipment Suppliers (NCAMES). "The bottom line is, the profit per box is vastly reduced from the prior contract, and providers will have to wait longer for their money." Providers will also have more paperwork. To be paid, providers will have to bill the state for part of the reimbursement, and apply to Roche for rebates on the supplies to make up the difference. Under the Prodigy contract, the rebate was on the meters; the state reimbursed for the supplies. "Even with a rebate back from Roche, it isn't enough," said Kim Government recovered $5.6B in FY 2011 WASHINGTON – The Obama Admin- istration announced in December that it recovered 167% more in fraudulent payments this year com- pared to last year, and it has plans in place to do even better in years to come. In all, the administration says it recovered $5.6 billion in fraudu- lent payments in fiscal year 2011, according to a release. Competitive bidding and the power mobility device demo proj- ect were listed among more than a dozen efforts the administration says will help fight fraud in the future. Competitive bidding, which will expand to 100 areas by 2013, is intended to be a "stricter requirement" for HME, which has "historically presented a high risk of fraud," according to the release. Other fraud efforts as a result of a $350 million investment under the Affordable Care Act: tougher sentences and penalties; better coordination across government; and required compliance pro- grams. HME Brummett, vice president of con- tracting and reimbursement for Greensboro-based Advanced Home Care. "You couldn't even cover the cost of shipping." For providers left holding inven- tory from Prodigy—it's not a com- monly used brand—the state said it would allow providers to continue to dispense the company's products through March 14, 2012. That only goes so far, say providers. "The state gave us a grace period, but Prodigy didn't," said Kimberly Lynn, HME operations manager for Carolina Apothecary in Reidsville. "Prodigy cut off our rebates on Nov. 15 when the contract changed." Ultimately, it's the beneficiaries who will suffer most, say provid- ers. Brummett said her company planned to start transitioning its Medicaid patients to other provid- ers in January, and Bowen has heard from several other providers who said the same thing. "I don't know a whole lot of pro- viders who are willing to partici- pate," she said. "I think there are going to be huge patient access issues." HME State News 11