On Oct. 12, the subsidiary, Arriva Medical, received a notice that its Medicare enrollment would be revoked on Nov. 4, according to Alere. CMS alleged Arriva Medical submitted claims for 211 deceased patients over the course of five years.
However, Alere believes the Medicare claims in question were submitted in response to valid refill orders from Medicare beneficiaries or their caregivers and said Arriva has not received or retained improper reimbursement for these claims.
A fact sheet, which Alere released on its website, provides additional information regarding Arriva Medical’s relationship with CMS and its enrollment in the National Mail Order Competition Bid Program for diabetes testing supplies.
Here are eight things to know about the issue.
1. In the last five years, Arriva Medical, the largest contract supplier under the Medicare National Mail Order Competitive Bid Program, serviced more than 970,000 Medicare beneficiaries, resulting in nearly 5.8 million claims, Alere said.
2. CMS alleges Arriva submitted 211 claims for deceased patients during the five-year period from April 15, 2011, through April 25, 2016; however, the CMS letter only identifies 47 of the 211 claims, according to Alere. The 211 claims allegedly at issue constitute approximately 0.00038 percent of all claims submitted during the five-year period.
3. Alere alleges updates to the HIPAA Eligibility Tracking System, which is the CMS system used to determine Medicare beneficiary eligibility (including dates of death), often do not give suppliers adequate time to identify deceased patients prior to billing for properly initiated reorders of covered medical supplies.
4. Arriva’s access to HETS was restricted by an agreement with CMS, causing further limitations on beneficiary eligibility verifications, Alere also contends.
5. Alere said the company believes this matter is a consequence of the challenges in obtaining timely and accurate beneficiary eligibility data from CMS.
6. CMS officials confirmed the agency sent a letter to Arriva and Alere terminating their Medicare provider billing “for historic issues that are not publicly disclosed.”
7. CMS officials also noted that through this process the agency’s policy offers every healthcare provider and supplier the option to appeal the decision. And that’s exactly what Arriva is doing. “If Arriva Medical wins our appeal, as anticipated, we will bill Medicare for any supplies shipped to covered patients during this period, to the extent allowable. You will be responsible for your normal copayment and deductible. However, should Arriva Medical lose the appeal, you, our valued patient, will not be billed for any supplies shipped to you during the appeal period,” Alere said in a letter on its website. In the meantime, though, Arriva said it continues to service all its customers without service interruptions.
8. In light of the fact Arriva is no longer enrolled in Medicare, people with Medicare benefits also have the option of locating another mail order supplier for their diabetes testing supplies by searching the Medicare DMEPOS Competitive Bidding Supplier Directory. CMS officials said a Medicare beneficiary, family member or trusted representative can also call 1-800-MEDICARE and be connected to a customer service representative who can assist them.
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