"Lymphedema" Compression Pumps (and fraud)

[heybrother]

I had a weird experience the other day that makes me think I wrote my last SCD type / lymphedema device (and I've written maybe 2-3 total). Without going into more details - how I think I wrote it and how the rep submitted it seemed to be two different things. Additionally, the more I read about it this morning the more I think this being covered by Medicare/insurance is supposed to be tight. My historic prescriptions were for long term ulcers.

I'm curious - does anyone else have reps from compression type companies coming by your office trying to get your write devices for patients?

My concern is - you have a company with sales people pushing what is apparently an almost $7K device telling you what the qualifications/pushing you to put certain diagnoses. I feel like if this blows up you are suffering a massive exposure/risk because you are facilitating an enormous expense.

Anyone have any insights. I may just be seeing fraud around every corner.

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[Feli]

If you're talking about the big blow-up sleeves that go up to hip level, I saw those reps occasionally in Michigan... not so much in SW.

I send the very few true lymphedema pts I get to PT places that do lymphedema (with MD oversight) or to the hospital-employed wound masters that have 2 or 3 wound nurses working with them.

I agree fully... I don't really want to enabling anything crazy expensive that I don't know much about (moto scooters, lymph systems, ongoing home care, home PT sessions, various home DME, etc). It is almost no benefit and surely puts a target on your NPI when you're PP. I will leave that stuff to the NH or house call pods and the hospital social workers.

 

[heybrother]

If you're talking about the big blow-up sleeves that go up to hip level, I saw those reps occasionally in Michigan... not so much in SW.

I send the very few true lymphedema pts I get to PT places that do lymphedema (with MD oversight) or to the hospital-employed wound masters that have 2 or 3 wound nurses working with them.

I agree fully... I don't really want to enabling anything crazy expensive that I don't know much about (moto scooters, lymph systems, ongoing home care, home PT sessions, various home DME, etc). It is almost no benefit and surely puts a target on your NPI when you're PP. I will leave that stuff to the NH or house call pods and the hospital social workers.

This. I got referred someone for a wound consult. Next thing I know I'm receiving notes asking me to sign for ongoing at home nursing care months after the fact for a wound that is already healed or never came to see me again or that I never really thought needed at home nursing care to begin with. I read it and think - is this still happening? A guy from a at home thing barged past our front desk the other day trying to tell me I could charge for some sort of monitoring of their services. Ugh. To the best of my ability I only want to deal with the things I can directly control in my office but our signature opens the doors to all these other people.

 

[dtrack22]

I had a weird experience the other day that makes me think I wrote my last SCD type / lymphedema device (and I've written maybe 2-3 total). Without going into more details - how I think I wrote it and how the rep submitted it seemed to be two different things. Additionally, the more I read about it this morning the more I think this being covered by Medicare/insurance is supposed to be tight. My historic prescriptions were for long term ulcers.

I'm curious - does anyone else have reps from compression type companies coming by your office trying to get your write devices for patients?

My concern is - you have a company with sales people pushing what is apparently an almost $7K device telling you what the qualifications/pushing you to put certain diagnoses. I feel like if this blows up you are suffering a massive exposure/risk because you are facilitating an enormous expense.

Anyone have any insights. I may just be seeing fraud around every corner.

Home lymphedema pumps are a covered device under medicare part B. I wouldn’t worry about it.

I can’t remember everything that the patient needs to have documented, but it’s supposed to be true primary or secondary lymphedema and I think it was 6 months of failed conservative therapy that includes graduated compression stockings and other compressive wraps. Don’t necessarily have to have a wound. We have an OT in our wound care clinic that does the lymphedema therapy and I’ve signed off or documented in my note once or twice now for patients to get pumps.

As long as you are following the guidelines and aren’t making stuff up in the patients chart to do it, you’re fine

 

[DYK343]

Home lymphedema pumps are a covered device under medicare part B. I wouldn’t worry about it.

I can’t remember everything that the patient needs to have documented, but it’s supposed to be true primary or secondary lymphedema and I think it was 6 months of failed conservative therapy that includes graduated compression stockings and other compressive wraps. Don’t necessarily have to have a wound. We have an OT in our wound care clinic that does the lymphedema therapy and I’ve signed off or documented in my note once or twice now for patients to get pumps.

As long as you are following the guidelines and aren’t making stuff up in the patients chart to do it, you’re fine

This.
Lymphedema is such a horrible thing for people. If it helps - and they truely need it - Ill sign.