Claim to Fame

On the Claim to Fame DME podcast, Kevin Gearheart, president and partner of Rehab Medical, explains how complex rehab technology (CRT) differs from other DME because it is highly specialized, involves many stakeholders (patients, physicians, caregivers, therapists, ATPs, and insurers), and requires a longer, carefully managed process focused on speed and communication. He shares why he’s committed to the mission—helping patients regain mobility and supporting employee growth—and describes Rehab Medical’s transition from standard DME and respiratory to CRT, including a key shift from a sales-driven approach to clinical service excellence. Gearheart discusses barriers such as documentation delays, payer prior authorizations, fraud-and-abuse scrutiny, reimbursement pressures, and narrow networks that restrict access, especially in rural areas, and highlights advocacy efforts. He also outlines technology and AI priorities to automate repeatable tasks, improve document review and communication, and find data trends while keeping care personal, plus equipment innovations and a focus on streamlining access over the next 5–10 years.

On the Claim to Fame DME podcast, hosts Alex and Wayne interview healthcare attorney Jeff Baird of Brown & Fortunato, who describes his firm’s nationwide work with DME suppliers and other providers across regulatory counseling, litigation defense, employment, and M&A. Baird traces the DME industry’s growth from Medicare’s creation in 1965 through a largely unregulated period to increased fraud scrutiny, post-payment audits, competitive bidding since 2009, expanding managed care (with 54% of Medicare beneficiaries in Medicare Advantage), and heightened PTAN revocations for technicalities. He warns that upcoming competitive bidding for “soft goods” (urological supplies, braces, ostomy, CGMs) will likely leave only 6–8 Medicare contracts per category, forcing many small suppliers to recalibrate. He discusses private equity pressures creating compliance risk (including the Medicare CPAP payment prohibition), diversification via Medicare Advantage and retail cash models, the need for state licensure and sales tax awareness when shipping, and emphasizes retaining experienced DME counsel, focusing on niches, and engaging in industry advocacy.

On the Claim to Fame DME podcast, Alex and Wayne interview BJ Anderson, president of QP3 Training Systems, a second-generation family business specializing in growing organic DME and CRT revenue through referral sales training. Anderson says many teams fail to grow referrals because reps don’t explicitly ask for the business, don’t define differentiators, and get commoditized by selling products instead of outcomes. He argues most teams lack process and confidence, not knowledge, and emphasizes questioning referral sources to solve their problems, keeping patients out of the hospital, and engaging all stakeholder roles (gatekeepers to physicians). Anderson defines predictable “clean, billable” referrals as driven by reps who know good vs. bad orders, train sources to submit complete documentation, and align sales and operations to avoid backlog, delays, and lost trust.

On the Claim to Fame DME podcast, hosts interview David Gelbard, CEO and co-founder of Parachute Health, about building a national DME e-prescribing network. Gelbard explains Parachute was inspired by his father not receiving a post-surgery walker due to a failed fax process, and describes the platform as enabling clinicians to place online DME orders that are validated against insurance criteria to reduce rework and delays. He discusses why fax persists—fragmented systems, data interoperability gaps, and trust issues across clinicians, DMEs, and payers—and compares e-prescribing to e-commerce’s qualified orders, lower processing costs, and faster payment. He also outlines new efforts to measure and surface DME service quality via patient satisfaction scores, Parachute’s focus on transparency and auditability, the next priority of faster payer authorization/payment, practical uses and limits of AI, and advice for healthcare founders to be patient and listen to customers.

On the Claim to Fame DME podcast, Alex and Wayne interview Jason Ivey, National Accounts Manager at Motif Medical, a maternity-focused manufacturer offering breast pumps plus pregnancy supports, postpartum recovery products, milk storage bags, and billable resupply parts. Ivy explains that maternal health is a growing diversification opportunity for DME providers amid reimbursement cuts and competitive bidding in other categories, with ACA-mandated breast pump coverage making access clearer and often simpler. He describes what was historically broken in the insurance pump experience, Motif’s emphasis on DME support, pricing, and using provider feedback and mom test groups for product development. The discussion covers wearable pump demand, patient education beyond pumps to ancillary covered items, the importance of provider support to build long-term relationships, and Motif’s planned pregnancy-validated blood pressure monitor. Ivy advises providers to invest time, understand payer mix and billing rules, and align product offerings to reimbursement realities.

On the Claim to Fame DME podcast, healthcare attorney Stephen Bittinger of Polsinelli explains how he defends providers against payer audits and sues payers for unpaid or denied claims. He says DME suppliers are frequent audit targets due to complex, changing rules, often identified through payer data mining or watch lists. Common provider mistakes include poor document production; he advises making records organized, chronological, and easy for auditors. He recommends legal counsel especially for UPIC or Medicaid MFCU audits and whenever statistical sampling and extrapolation is involved, where small sampled overpayments can be projected into large demands over long look-back periods (commercial typically two years; Medicare four). He describes rising AI-driven denials and litigation, warns providers that AI doesn’t change claim-submission responsibility, and flags CMS’s WISER AI preauthorization pilot in six states. His core advice: know LCD/NCD requirements, maintain QC, and conduct quarterly internal self-audits. (Stephen notes he does not represent NikoHealth or endorse its services).

On the Claim to Fame DME podcast, Patty Gatter, founder of The Breastfeeding Shop, shares how she started the company in 2015 as a mom and breastfeeding advocate after recognizing that the Affordable Care Act would make breast pumps a covered insurance benefit starting January 2015. Drawing on prior DME and manufacturing experience plus social media marketing, she grew quickly by going direct-to-consumer online rather than traditional hospital-based DME sales, reaching a breakout point in July 2015. She discusses early challenges (credentialing, contracting, billing, hiring, workflows), the importance of authenticity, and today’s maternal health trends: wearable pumps, new features like warming/massaging, newly covered pump supplies (valves/membranes), and interest in pelvic floor therapy products, including Medicare approval of non-implantable pelvic floor stimulation. She emphasizes making ordering easy and fast, like an Amazon experience, and offers entrepreneurial advice focused on grit and doing the “unfun” work.

On the Claim to Fame DME podcast, Alex and Wayne interview Matt Edwards, CEO of Gemcore, a second-generation family business founded in 1992 that evolved from an over-the-counter mail order catalog into diabetes supply distribution after seeing demand and limited distribution for diabetes devices. Edwards shares his path from entry-level sales to leadership and lessons on understanding workflows firsthand, open communication, networking, and hiring people who complement his weaknesses. He explains how healthcare distribution has become more regulated and technology-driven, requiring clean, pharmaceutical-grade facilities, automation, and software/AI prioritization. The discussion covers rapid CGM adoption, broader eligibility for pumps/CGMs (including type 2 patients), pharmacy vs DME channel dynamics, and concerns about CMS competitive bidding and potential access issues. Edwards predicts DMEs will modernize through APIs, eligibility visibility, and improved patient tracking, and advises young leaders to focus on data skills and face-to-face networking.

On the Claim to Fame DME podcast, Eran Orr, founder of XR Health and former Israeli F-16 pilot, explains how a whiplash injury led him to build a VR therapy company that now offers 150+ FDA Class 2 applications across physical therapy, occupational therapy, mental health, and pain management. He discusses the evolution from expensive, tethered VR to affordable Meta Quest hardware and how CMS reimbursement for VR-based cognitive behavioral therapy—spurred by AppliedVR—opened VR as durable medical equipment, now used in 25 states with one million sessions last year. Orr describes how XR Health repackages Quest headsets for medical-only use, ships to patients, supports onboarding, and enables clinician monitoring and tailoring, including RTM opportunities. He cites high adherence (97%) versus traditional drop-off, and advises entrepreneurs to align FDA, reimbursement, clinician buy-in, and patient adoption.

In the 50th episode of the Claim to Fame DME podcast, hosts Alex and Wayne interview Michael Kutsak , CEO and founder of NikoHealth, who previously owned and operated a DME and experienced frustrations with outdated, fragmented software and workflows. Kutsak explains how legacy systems force providers to juggle disconnected tools across order intake, compliance, logistics, inventory, billing, and reimbursement, making training and scaling difficult. He describes NikoHealth’s goal of an end-to-end DME operating system with a single source of truth, plus an API-first approach for extensibility, and notes the biggest adoption hurdle is industry resistance to change and the burden of switching systems. They discuss current challenges including reimbursement pressure, complex billing and audits, staffing constraints, competitive bidding, and the growing need for automation and AI. Kutsak advises providers to embrace change and highlights the importance of customer-driven product development and strong team culture.