No CPAP Supplies DME says under audit

[greatunclebill]

i could find nothing about individual audits, but plenty about doctor audits. if something smells, they will take a sampling of patient accounts and audit them. so, they may suspect your doctor of something as simple as sloppy paperwork/incorrect coding.

[Janknitz]

ave no idea if they are in trouble. They have been difficult to deal with. After my first visit with Sleep Dr. after I started CPAP I realized I should be getting new cushions, it took me 2 weeks to finally get one. After 90 days they never called so I called them and got the run around so I called the Sleep Dr. and they called them. I was assured I would get supplies today and they came up with this. Just curious if anyone has experienced this? I may try and call Medicare Monday.

There's a lot of paperwork just to supply you with new nasal pillows with almost no profit. It may be an excuse not to bother.

[Hang Fire]

I suspect that the use of the various "nipple butters" available may contribute to some accelerated deterioration of nasal cushions. Not certain, though.

The experience I had with petroleum jelly is that it causes discoloration of the silicone over a two or three month time span. Noticeable structural deterioration takes a year or longer. Lanolin cream would take longer to have an effect.

[chunkyfrog]

Petroleum products in Vaseline is similar to chemicals in the silicone, thus making it more reactive.
The organic hydrocarbons in lanolin are less related to silicone, and therefore less reactive.

[palerider]

Petroleum products in Vaseline is similar to chemicals in the silicone, thus making it more reactive.
The organic hydrocarbons in lanolin are less related to silicone, and therefore less reactive.

http://partners.coleparmer.com/techinfo/chemcomp.asp says that petrolatum (petroleum jelly) is rated "D" for silicone, or, Severe Effect, not recommended for ANY use.

[Notacpack]

Medicare audits are rampant with pap users thanks to the dmes that abased the system for years. Audits can take years to resolve and it is up to the dme if they want to continue to provide supplies or not. Until the audit is resolved, dme won't get paid. Sometimes it is as simple as turning in the document that was forgotten such as notes prior to PSG or it's a big huge issue and has to go all the way to a judge.

[chunkyfrog]

{{{death panel?}}}
So, it seems that stocking up on supplies may trigger an audit;
--while at the same time could be our best safeguard against one.
The system is so very broken.

[SewTired]

In my experience, Medicare audits aren't very long. My brother's new walker was delayed about 3 weeks because of a Medicare audit. I know that my Dad's account was audited (they contacted him), but they never delayed his oxygen supplies.

[chunkyfrog]

That is good news.
The first place to call when something like this happens is to call Medicare--
and RECORD the conversation! Some states require consent,
but the Medicare reps should not object, unless they are doing something "wrong".

[jtravel]

Too much Medicare fraud is taking place so they have to act like they are doing something about it.
Most of the time it is misguided and innocent patients are inconvenienced.
some are getting replacement masks, pillows and machines when they don't really need them and then selling on eBay or elsewhere for extra income.
Same problem going on with the elderly getting narcotic pain medications and then selling them.
If their is a way to take advantage of the system some will find a way to make it work for them.
The Majority however has to suffer because of those who use and abuse the system for their own gain.

[LSAT]

Too much Medicare fraud is taking place so they have to act like they are doing something about it.
Most of the time it is misguided and innocent patients are inconvenienced.
some are getting replacement masks, pillows and machines when they don't really need them and then selling on eBay or elsewhere for extra income.
Same problem going on with the elderly getting narcotic pain medications and then selling them.
If their is a way to take advantage of the system some will find a way to make it work for them.
The Majority however has to suffer because of those who use and abuse the system for their own gain.

+1

[ChicagoGranny]

Too much Medicare fraud is taking place so they have to act like they are doing something about it.
Most of the time it is misguided and innocent patients are inconvenienced.
some are getting replacement masks, pillows and machines when they don't really need them and then selling on eBay or elsewhere for extra income.
Same problem going on with the elderly getting narcotic pain medications and then selling them.
If their is a way to take advantage of the system some will find a way to make it work for them.
The Majority however has to suffer because of those who use and abuse the system for their own gain.

+2

[exersize_freak]

I see that you are from TX. Medicare has been shutting down a lot of DME suppliers for fraud in TX&FL lately. While I do not know DME's specific situation that could be the case. I would get a new DME ASAP.

[chunkyfrog]

Texas and Florida; hmmm, very interesting.
I noticed a lot of TX & FL in the Medicare competitive bid list for mail order diabetic supplies.
---also a lot of oddball outfits that I've never heard of; most of which only carry no-name meters/strips. WTF!

[klm49]

Got a call earlier in the week from the DME (a person I had not talked to) and she explained that my machine is what was in audit and that she had finally gotten all the paper work from my Sleep Dr. and had filed it. She said she would check in a week or 2 and see if they had taken my machine off audit so I could receive my 3 mos. supplies. When she told me she had finally gotten the paper work from the sleep Dr. I cut her off and told her that I was in Sleep Dr. on 7/11 and had specifically asked them about the supposed missing paper work and she just ignored me. Today I get a phone call from the local branch of this outfit and the lady tells me I am now off audit and she is ordering my 3 mos.supplies and I should get them Monday! I guess I should be glad now. I would switch DME's were it not for having to start over with a new machine and having to have Sleep Dr. verify the 60-90 day compliance. After the initial 12 (13) mos. and the machine is mine I may be looking for a new DME because so far these clowns don't impress me. I had just looked at my medicare payments yesterday and noticed a claim by them for 4/8 which was when I got my machine. I thought I hadn't seen this before but decided I had just missed it when looking before. After they called today I looked on Medicare again and I see nothing new, but I looked at the 4/8 claim and clicked on it. It was only processed yesterday but was submitted 6/21. Funny they would be 3 months behind collecting rent for my machine. This is all new to me.