Claim to Fame

NikoHealth
  • 5.0 (2)
  • Entrepreneurship
  • Updated Weekly

Go behind the scenes with the leaders shaping the DME industry. Claim to Fame is where the DME community comes to talk shop. Hosted by NikoHealth, we spotlight the builders, leaders, and operators driving the future of this rapidly evolving industry. Hear the inside stories, lessons, and wins from the people leading the future of DME.

  1. 2d ago

    DME Audits, UPICs, Extrapolation, and AI: Legal Insights with Stephen Bittinger

    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).

  2. Aug 13

    Patty Gatter of The Breastfeeding Shop: Building a Direct-to-Consumer Maternal Health DME Brand

    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.

  3. Aug 6

    From Basements to Boardrooms: Gemcore's CEO, Matt Edwards, on Revolutionizing Diabetes Tech

    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.

  4. Jul 30

    XRHealth’s Eran Orr on VR as Medicare-Reimbursable DME for Rehab, Pain, and Mental Health

    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.

  5. Jul 23

    NikoHealth CEO and Founder, Michael Kutsak on Modernizing DME Software, Simplifying DME Operations, and Preparing for the Future

    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.

  6. Jul 9

    CCS Medical CTO Richard Mackey on AI, Data, and the Future of DME in Chronic Care Management

    On the Claim to Fame DME podcast, hosts Alex and Wayne interview Richard Mackey, CTO of CCS Medical, a 30+ year company evolving from traditional DME into chronic care management, especially for diabetes. Mackie describes how AI and analytics can digitize patient interactions, connect fragmented systems, and deliver more personalized, multi-channel experiences across portals, texts, emails, and live conversations. He explains CCS’s expansion beyond shipping supplies to providing coaching and predictive analytics, including identifying CGM users at risk of discontinuation (noting up to 40% struggle to stay on therapy). Mackie discusses changing patient expectations, emphasizing increased comfort with digital tools among older adults, and outlines AI’s real value in conversational documentation and workflow efficiency while keeping humans in the loop and clinicians central. He highlights adoption success factors such as integrated workflows, organizational change management, and regulatory compliance.

  7. Jul 2

    Bellevue Healthcare CEO Joel Gallion on Advocacy, Organic Growth, and AI in DME

    This week Alex and Wayne are joined by Joel Gallion, President and CEO of Bellevue Healthcare, discusses the company’s evolution and the broader DME landscape. Founded in 2000, Bellevue now has 23 locations across Washington, Oregon, and Idaho, and Gallion shares how early “wear many hats” bootstrapping (starting with hospice) shaped a people-first culture and long-tenure leadership. He recaps advocacy work at NCART and AAHomecare legislative events, emphasizing the need to educate policymakers on home care’s value in keeping patients out of acute settings. Gallion explains Bellevue’s organic growth approach, adding services like complex rehab through internal talent, and the advantages of independence, including the ability to decline unsustainable business. He highlights shifting consumer expectations, technology’s role in visibility, and practical AI use such as automating fax intake, with future disruption expected in revenue cycle processes.

  8. Jun 25

    Daybreak’s Eric Mongeau on the Shift Beyond CPAP: Reducing Abrasion, Scaling DME, and At-Home Oral Appliance Therapy

    On this week's episode of the Claim to Fame podcast, Eric Mongeau shares his 16-year sleep industry path from ResMed to scaling Aeroflow and now leading commercial strategy at Daybreak, arguing the industry is entering a major shift with more diagnostic and therapy options. He credits Aeroflow’s growth to reducing “abrasion,” embracing technology and automation, and building a consumer-like patient experience that compressed intake, pricing, paperwork, AI mask fitting, and telehealth scheduling into seconds, while emphasizing people, learning and development, and aligning the “three Ps” (patient, provider, payer). Mongeau discusses healthcare fragmentation, policy misalignment, and the need for payer/provider collaboration, then explains Daybreak’s at-home oral appliance model using telehealth, impressions, teledentistry screening, U.S. manufacturing, and gradual titration, plus how DMEs can convert CPAP drop-offs into oral appliance therapy; he also describes awareness efforts like state Sleep Apnea Awareness Month resolutions.

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Ratings & Reviews

5
out of 5
2 Ratings

About

Go behind the scenes with the leaders shaping the DME industry. Claim to Fame is where the DME community comes to talk shop. Hosted by NikoHealth, we spotlight the builders, leaders, and operators driving the future of this rapidly evolving industry. Hear the inside stories, lessons, and wins from the people leading the future of DME.

Information

  • Creator
    NikoHealth
  • Years Active
    2025 - 2026
  • Episodes
    55
  • Rating
    Clean
  • Copyright
    © NikoHealth
  • Show Website
    Claim to Fame