What changed in this filing

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Item 1. Business

2026-03-04 compared with 2025-03-10 · 66 added, 73 removed, 187 unchanged (43% of the section changed)

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Viemed Healthcare, Inc.

(the "Company" or "Viemed"), through its subsidiaries, is a provider of home medical equipment ("HME") and post-acute respiratory healthcare services in the United States.

(the "Company" or "Viemed"), through its subsidiaries, is a provider of home medical equipment ("HME") and post-acute healthcare services in the United States, with a focus on respiratory, chronic care, and women’s health products and services.

The Company’s primary service offerings are focused on effective in-home treatment with clinical practitioners providing therapy and counseling to patients in their homes using cutting edge technology.

Viemed’s primary objective is to focus on the organic growth of the business and thereby solidify its position as one of the United States' largest providers of in-home therapy for patients suffering from respiratory diseases.

Viemed's respiratory care programs are designed specifically for payors to have the ability to treat patients in the home for less total cost and with a superior quality of care.

Viemed's services include respiratory disease management (through the rental of various HME devices), neuromuscular care, in-home sleep testing and sleep apnea treatment, oxygen therapy, the sale of associated supplies, and healthcare staffing services.

Viemed expects to grow through expansion of existing service areas as well as in new territories through a cost efficient launch that reduces location expenses.

Viemed’s primary objective is to drive growth by increasing the number of patients served and the level of care provided through its technology-enabled, home-based clinical care and chronic disease management model.

Viemed's care programs are designed specifically to treat patients in the home for less total cost and with a superior quality of care.

Viemed seeks to grow through expansion of existing service areas as well as in new territories through a cost efficient launch that reduces location expenses.

The Company currently serves patients in all 50 states of the United States.

Viemed anticipates expanding its workforce of respiratory therapists ("RTs") to support the Company's growth and ensure the high service model is maintained in the home.

As of December 31, 2024, we employed 404 licensed RTs, representing approximately 34% of our company-wide employee count.

Viemed anticipates expanding its workforce of licensed clinical practitioners, including respiratory therapists ("RTs") to support the Company's growth and ensure the high service model is maintained in the home.

As of December 31, 2025, the Company employed 401 licensed RTs, representing approximately 29% of the Company-wide employee count.

Beyond fulfilling its internal staffing needs, Viemed also provides healthcare staffing and recruitment services, offering tailored workforce solutions to external healthcare institutions and partners seeking qualified clinical professionals.

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The continued trend of servicing patients in the home rather than in hospitals is aligned with Viemed’s business objectives and management anticipates that this trend will continue to offer growth opportunities for the Company.

Viemed expects to continue to be a solution to the rising health costs in the United States by offering more cost-effective, home-based solutions while increasing the quality of life for patients fighting serious respiratory diseases.

Corporate Information

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is a holding company incorporated in British Columbia under the Business Corporations Act in December 2016.

The common shares of Viemed trade on the Nasdaq Capital Market under the trading symbol "VMD".

The common shares of Viemed trade on the Nasdaq Stock Market LLC ("NASDAQ") under the trading symbol "VMD".

Viemed’s registered and records office is located at Suite 2800, Park Place, 666 Burrard Street, Vancouver, British Columbia V6C 2Z7 Canada and its principal executive office is located at 625 E.

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Viemed provides home medical equipment through the following service programs:

◦ Respiratory disease management , including treatment of Chronic Obstructive Pulmonary Disease (“COPD”), aims to improve quality of life and reduce hospital readmissions by using proven methodology and leading technologies, such as non-invasive ventilation (“NIV”), percussion vests, and other therapies.

◦ Respiratory disease management , including treatment of Chronic Obstructive Pulmonary Disease (“COPD”), is designed to improve quality of life and reduce hospital readmissions by using proven methodology and leading technologies, such as non-invasive ventilation (“NIV”), percussion vests, and other therapies.

Viemed provides ventilation (both invasive and non-invasive) and related equipment and supplies to patients suffering from COPD through a high-touch model.

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◦ Sleep apnea management provides sleep solutions and/or equipment such as Positive Airway Pressure (“PAP”), the AutoPAP (automatic continuous positive airway pressure), and BiPAP machines.

• In-home sleep testing :

Viemed provides in home sleep apnea testing services, which is an alternative to the traditional sleep lab testing environment.

◦ Women’s health provides breast pumps and related lactation equipment and supplies, including fulfillment and support services, to eligible patients as part of its home medical equipment offerings.

• Healthcare staffing :

Viemed provides healthcare staffing and recruitment services to supplement the workforce needs of third-party healthcare facilities by utilizing its network of healthcare professionals.

While Viemed plans to continue investigating and introducing new complementary products and services and further expanding the coverage of existing products, home ventilation (both invasive and non-invasive) is expected to continue to represent the majority of Viemed’s revenue.

Patients suffering from neuromuscular or respiratory diseases experience severe difficulty in breathing and require assistance from a ventilator to effectively move air in and out of their lungs.

Invasive and non-invasive ventilation differ in how the air is delivered to the person.

Invasive ventilation delivers air via a tube inserted into the windpipe.

Non-invasive ventilation delivers air through a sealed mask that can be placed over the mouth.

The Centers for Medicare and Medicaid Services (“CMS”) Medicare National Coverage Determinations Manual stipulates that ventilators are covered for the treatment of conditions associated with neuromuscular diseases, thoracic restrictive diseases, and chronic respiratory failure consequent to chronic obstructive pulmonary disease.

Ventilators are also included in Medicare’s Frequently & Substantially Serviced payment category and are reimbursed under the Healthcare Common Procedure Coding System (“HCPCS”) codes E0465 (invasive ventilation), E0466 (non-invasive ventilation), E0467 (multi-function ventilation) and E0468 (dual-function ventilation).

While Viemed continues to evaluate and introduce new complementary products and services and expand existing offerings, respiratory care services, including home ventilation, are expected to continue to represent a significant portion of Viemed’s revenue, alongside contributions from other product and service offerings.

Patients with neuromuscular conditions or chronic respiratory diseases may experience severe difficulty breathing and require ventilatory support to assist with effective air exchange.

Ventilatory support may be delivered invasively, through a tube inserted into the airway, or non-invasively, through a sealed mask placed over the nose and/or mouth.

Medicare coverage for ventilators is addressed under National Coverage Determination (“NCD”) 280.1, Durable Medical Equipment Reference List, which provides for coverage of ventilators for the treatment of neuromuscular diseases, thoracic restrictive diseases, and chronic respiratory failure consequent to COPD.

In addition, the Centers for Medicare & Medicaid Services (“CMS”) has issued a separate NCD establishing specific national coverage criteria for non-invasive positive pressure ventilation (“NIPPV”), respiratory assist devices (“RADs”), and home mechanical ventilators (“HMVs”) used in the home for the treatment of chronic respiratory failure related to COPD.

The COPD-specific NCD includes defined clinical criteria for initial and continued coverage, including documentation of medical necessity and ongoing patient use.

Coverage for ventilator use outside the scope of the COPD-specific NCD continues to be governed by NCD 280.1 and applicable Medicare policies, including determinations by Medicare Administrative Contractors.

Viemed’s patients are served by RTs who are each licensed members of the American Association for Respiratory Care (“AARC”).

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William Frazier, is a board-certified pulmonary disease specialist and oversees clinical protocols.

Viemed sources hardware from vendors and pairs them with industry leading respiratory therapy.

The emerging nature of the market presents risks that vendors may not be able to provide equipment to satisfy demand.

Viemed sources respiratory equipment from vendors and pairs them with industry leading respiratory therapy.

Viemed has historically funded patient related capital expenditures through cash generated from operations or financing through an affiliate of its primary vendors.

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To attain and maintain accreditation, companies are required to institute policies and procedures that, among other things, formalize the interaction of the company with patients.

Accrediting bodies that are approved by CMS will perform audits of these policies and procedures every three years.

Accrediting bodies that are approved by CMS historically performed audits of these policies and procedures every three years.

Should a company fall out of compliance with the requirements of the accrediting body, expulsion from the Medicare program could follow.

In December 2008, we became a Durable, Medical Equipment, Prosthetics, Orthotics, and Supplies accredited Medicare supplier by the Accreditation Commission for Health Care for our solutions.

Our Medicare accreditation must be renewed every three years through passage of an on-site inspection.

We last renewed our accreditation with Medicare in August 2024.

In December 2008, we became a Durable, Medical Equipment, Prosthetics, Orthotics, and Supplies ("DMEPOS") accredited Medicare supplier by the Accreditation Commission for Health Care for our solutions.

Historically, our Medicare accreditation had to be renewed every three years through passage of an on-site inspection.

We last renewed our accreditation with Medicare in August 2024, meaning our next renewal is scheduled for August 2027.

Once our current term of accreditation expires, we will become subject to updated accreditation requirements promulgated via federal rulemaking in December of 2025.

Beginning in 2027, Viemed’s business locations will be subject to new, unannounced accreditation surveys and reaccreditation processes every 12 months.

Additionally, any new business locations Viemed opens will be subject to immediate survey (as opposed to 30 days after beginning operations).

Maintaining our accreditation and Medicare enrollment requires that we comply with numerous business and customer support standards.

If we are found to be out of compliance with accreditation standards, our enrollment status in the Medicare program could be jeopardized, up to and including termination.

If we are found to be out of compliance with accreditation standards during an annual site visit, our enrollment status in the Medicare program could be jeopardized, up to and including termination.

CMS also requires that all durable medical equipment ("DME") providers who bill the Medicare program maintain a surety bond of $50,000 per National Provider Identifier (“NPI”) number which Medicare has approved for billing privileges.

We obtained surety bonds before the October 2009 deadline, and such bonds automatically renew annually.

In order to ensure that Medicare beneficiaries only receive medically necessary and appropriate items and services, the Medicare program has adopted a number of documentation requirements.

For example, the DME Medicare Administrative Contractor (“MAC”) Supplier Manuals provide that clinical information from the “patient’s medical record” is required to justify the initial and ongoing medical necessity for the provision of DME.

Some DME MACs, CMS staff and government subcontractors have taken the position, among other things, that the “patient’s medical record” refers not to documentation maintained by the DME supplier but instead to documentation maintained by the patient’s physician, healthcare facility or other clinician, and that clinical information created by the DME supplier’s personnel and confirmed by the patient’s physician is not sufficient to establish medical necessity.

It may be difficult, and sometimes impossible, for us to obtain documentation from other healthcare providers.

Moreover, auditors’ interpretations of these policies are inconsistent and subject to individual interpretation.

This is then translated to individual supplier error rates and aggregated into a Durable Medical Equipment, Prosthetics, Orthotics and Supplies (“DMEPOS”) industry error rate, which is significantly higher than other Medicare provider/supplier types.

High error rates lead to further audit activity and regulatory burdens.

DME MACs continue to conduct extensive pre-payment and post-payment reviews across the DME industry and have determined a wide range of error rates.

DME MACs have repeatedly cited documentation insufficiencies as the primary reason for claim denials.

If these or other burdensome positions are generally adopted by auditors, DME MACs, other contractors or CMS in administering the Medicare program, we would have the right to challenge these positions as being contrary to law.

If these interpretations of the documentation requirements are ultimately upheld, however, it could result in our making significant refunds and other payments to Medicare and our future revenues from Medicare may be significantly reduced.

We have adjusted certain operational policies to address the current expectations of Medicare and its contractors.

We cannot predict the adverse impact, if any, these interpretations of the Medicare documentation requirements or our revised policies might have on our operations, cash flow, and capital resources, but such impact could be material.

CMS maintains a Master List of Items Frequently Subject to Unnecessary Utilization.

This list identifies items that could potentially be subject to prior authorization as a condition of Medicare payment.

CMS has added home ventilators used with a non-invasive interface to the Master List of Items Frequently Subject to Unnecessary Utilization.

If CMS requires prior authorization requirements for noninvasive home ventilation, it could materially impact our business.

Additionally, CMS has implemented additional requirements for Medicare-enrolled DMEPOS suppliers involved in certain transactions.

If a DMEPOS supplier undergoes a change in majority ownership within 36 months of its initial Medicare enrollment or its most recent change in majority ownership, the Medicare enrollment will not transfer to the new owner.

A change in majority ownership is any direct transfer of 50% or more of a DMEPOS supplier’s ownership interest.

In such cases, the prospective majority owner must obtain a new Medicare enrollment and undergo a new accreditation process.

This new rule could impact our strategic growth plan, which involves the acquisition of other businesses, as these hurdles in securing a new Medicare enrollment or completing a new accreditation process could delay successful post-closing operations for certain acquisition transactions.

In those circumstances, these additional administrative steps could hinder the purchased entity’s ability to commence operations and seek reimbursement for services provided to Medicare beneficiaries.

Accordingly, Viemed’s overall financial performance could be negatively impacted in those circumstances.

Competitive Bidding Process

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The SPAs are determined by using bids submitted by DME suppliers.

In 2019, CMS included non-invasive ventilator products on the list of products subject to the competitive bidding program in Round 2021.

On March 9, 2020, CMS announced that due to the COVID-19 pandemic, the United States President's exercise of the Defense Production Act, public concern regarding access to ventilators, and the non-invasive ventilators product category being new to the competitive bidding program, non-invasive ventilators were removed as a product category from Round 2021.

On October 27, 2020, CMS announced that it had removed 13 of the 15 remaining product categories from Round 2021, including oxygen and PAP devices, because the payment amounts did not achieve expected savings.

As a result of these announcements, we retain the ability to continue to furnish non-invasive ventilators and oxygen and PAP devices for all of our Medicare accredited areas.

However, we are uncertain if non-invasive ventilators and oxygen and PAP devices will be included in future competitive bidding programs.

The current Round 2021 contracts expired on December 31, 2023 and CMS has not announced a new round of competitive bidding.

Historically, CMS announces new rounds of competitive bidding and starts the process approximately 18 months prior to the contract start date.

We cannot predict the outcome of the competitive bidding process for contracted supplier selection or the impact of the competitive bidding process on reimbursements to our existing customers.

CMS has modified the scope and timing of the competitive bidding program over time.

Non-invasive ventilators were previously included as a product category in Round 2021;

however, prior to implementation, CMS removed non-invasive ventilators from the program.

CMS subsequently removed a substantial number of additional product categories from Round 2021, including oxygen equipment and PAP devices, after determining that the program did not achieve expected savings.

As a result, Viemed has continued to furnish non-invasive ventilators, oxygen equipment, and PAP devices in its Medicare-accredited service areas without being subject to competitive bidding contract limitations for those products.

The Round 2021 competitive bidding contracts expired on December 31, 2023.

CMS has since issued updated guidance regarding the next round of the DMEPOS Competitive Bidding Program, indicating that the upcoming round will be limited to product categories within the Nationwide Remote Item Delivery (“RID”) program.

CMS has identified the next round RID categories to include certain Class II continuous glucose monitors and insulin pumps, urological supplies, ostomy supplies, hydrophilic urinary catheters, and select off-the-shelf braces.

Viemed does not furnish products within these categories and, based on currently available information, does not expect the next round of competitive bidding to apply to, or have a material impact on, its products or services.

The timing, scope, and structure of future competitive bidding rounds beyond the announced RID-focused program remain subject to change.

CMS may modify product categories, geographic coverage, or program requirements in future rounds, and we cannot predict whether respiratory-related products may be included in subsequent competitive bidding programs or the potential impact of any such inclusion on reimbursement rates, supplier participation, or our results of operations.

Several states require that DME providers be licensed in order to sell products to patients in that state.

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Many payors require accreditation under payor contracts.

Additionally, it is possible that state Medicaid programs, commercial payors, and Medicare Advantage Organizations could follow the Medicare Program’s lead and implement more stringent accreditation requirements with increased oversight.

If we lose accreditation at any location, it could have an adverse impact on our reimbursement under payor contracts.

General Regulatory Compliance and Health Care Reform

The evolving regulatory and compliance environment and the need to build and maintain robust systems to comply with different compliance or reporting requirements in multiple jurisdictions increase the possibility that a healthcare company may fail to comply fully with one or more of these requirements.

If our operations are found to be in violation of any of the health regulatory laws described below or any other laws that apply to us, we may be subject to penalties, including potentially significant criminal and civil and administrative penalties, damages, fines, disgorgement, imprisonment, exclusion from participation in government healthcare programs, contractual damages, reputational harm, administrative burdens, diminished profits and future earnings and the curtailment or restructuring of our operations, any of which could adversely affect our ability to operate our business, financial condition and our results of operations.

Reimbursement levels and coverage criteria under Medicare, Medicaid, and other government healthcare programs are governed by a statutory and regulatory framework shaped by multiple federal healthcare and budget laws, including the Patient Protection and Affordable Care Act, as amended (“ACA”), the Medicare Improvements for Patients and Providers Act of 2008 (“MIPPA”), the Deficit Reduction Act of 2005 (“DRA”), and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (“MMA”).

These statutes, together with subsequent legislative, regulatory, and administrative actions, have influenced reimbursement methodologies, coverage standards, and program administration, including an increased emphasis on medical necessity criteria, utilization controls, and value- and outcomes-based reimbursement models.

CMS and other federal agencies continue to implement and refine coverage policies, reimbursement frameworks, and supplier participation requirements through rulemaking, guidance, and coverage determinations, which may affect utilization patterns, coverage criteria, and reimbursement levels for home-based healthcare services.

Legislative and regulatory actions at the federal and state levels may be undertaken from time to time to contain or reduce healthcare spending, including through changes to reimbursement methodologies, coverage criteria, program funding, or supplier requirements, which could reduce reimbursement levels or otherwise limit coverage for certain products and services.

In addition, in 2025, Congress enacted the federal budget reconciliation legislation commonly referred to as the One Big Beautiful Bill Act (“OBBBA”), which includes a range of statutory and policy changes affecting federal healthcare programs.

Certain provisions of the OBBBA address Medicaid eligibility and renewal requirements, payment structures, and program funding, and provide states with additional flexibility in administering home- and community-based services.

While many of these provisions are scheduled to be implemented over multiple years, including beginning in 2027 and 2028, the legislation, together with future legislative or administrative actions, may result in changes to reimbursement levels, coverage criteria, program funding, or compliance requirements that could adversely affect providers of home-based healthcare services.

Adverse coverage or reimbursement determinations by government programs, or by commercial payors and Medicare Advantage plans that reference or align with federal healthcare policies, could further impact demand for our products and services and adversely affect our financial condition and results of operations.

Fraud and Abuse Regulations

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The costs of complying with privacy and security related legal and regulatory requirements are burdensome and could have a material adverse effect on our business, financial condition and results of operations.

General Regulatory Compliance and Health Care Reform

If our operations are found to be in violation of any of the health regulatory laws described above or any other laws that apply to us, we may be subject to penalties, including potentially significant criminal and civil and administrative penalties, damages, fines, disgorgement, imprisonment, exclusion from participation in government healthcare programs, contractual damages, reputational harm, administrative burdens, diminished profits and future earnings and the curtailment or restructuring of our operations, any of which could adversely affect our ability to operate our business, financial condition and our results of operations.

In March 2010, the Affordable Care Act (“ACA”) was enacted into law in the United States.

This healthcare reform, which included a number of provisions aimed at improving the quality and decreasing the cost of healthcare, has resulted in significant reimbursement cuts in Medicare payments to hospitals and other healthcare providers in the healthcare reimbursement system, evolving toward value- and outcomes-based reimbursement methodologies.

It is uncertain what long-term consequences these provisions will have on patient access to new technologies and what impact these provisions will have on Medicare reimbursement rates.

Other elements of the ACA, including comparative effectiveness research, an independent payment advisory board and payment systems reform, including shared savings pilots and other reforms, may result in fundamental changes to federal healthcare reimbursement programs.

The Tax Cuts and Jobs Act of 2017 ("TCJA") repealed penalties for noncompliance with the requirement for insurance coverage known as the “individual mandate.” This change could affect whether individuals enroll in health plans and could impact insurers with which we contract.

Other changes to the ACA could impact the number of patients who have access to our products.

Existing and additional legislative or administrative reforms, or any repeal of provisions, of the U.S.

healthcare reimbursement systems may significantly reduce reimbursement or otherwise impact coverage for our medical devices, or adverse decisions relating to our products by administrators of such systems in coverage or reimbursement issues could have an adverse impact on our financial condition and results of operations.

Third-Party Reimbursement

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CMS, which is the agency within the HHS that administers both Medicare and Medicaid, has the authority to decline to cover particular products or services if it determines that they are not “reasonable and necessary” for the treatment of Medicare beneficiaries.

A coverage determination for a product, which establishes the indications that will be covered, and any restrictions or limitations, can be developed at the national level by CMS through a National Coverage Determination (“NCD”) or at the local level through a Local Coverage Determination (“LCD”) by a regional DME MAC.

A coverage determination for a product, which establishes the indications that will be covered, and any restrictions or limitations, can be developed at the national level by CMS through a NCD or at the local level through a Local Coverage Determination (“LCD”) by a regional DME MAC.

CMS could issue new NCDs or the regional DME MACs could issue LCDs related to a full range of respiratory DME products.

If such NCDs or LCDs are issued or revised, they could significantly alter the coverage under Medicare and materially impact our business.

With respect to our ventilator products, an NCD for the DME Reference List, which has been effective since April 1, 2003, indicates that ventilators, including our products, are covered for the treatment of neuromuscular diseases, thoracic restrictive diseases, and chronic respiratory failure consequent to chronic obstructive pulmonary disease.

While the NCD for the DME Reference List has been updated, no separate NCD has been issued for ventilators.

On September 11, 2024, CMS initiated a national coverage analysis (NCA) for noninvasive positive pressure ventilation (NIPPV) in the home for treating chronic respiratory failure (CRF) due to COPD.

A decision is anticipated in 2025, though delays are possible.

We have actively participated in the coverage analysis process, including submitting a comment letter to CMS, and will continue to engage with CMS, HHS, and Congress on ventilator coverage issues.

A new NCD that clearly defines the medical necessity criteria for ventilator devices could significantly impact our business.

With respect to ventilators, NCD 280.1, Durable Medical Equipment Reference List, which has been effective since April 1, 2003, provides for Medicare coverage of ventilators for the treatment of neuromuscular diseases, thoracic restrictive diseases, and chronic respiratory failure consequent to COPD.

In addition, on September 11, 2024, CMS initiated a national coverage analysis to evaluate noninvasive positive pressure ventilation in the home for the treatment of chronic respiratory failure associated with COPD.

CMS issued a proposed decision memorandum on March 11, 2025, followed by a final NCD on June 9, 2025.

We actively participated in this process through formal comments and engagement with CMS, HHS, and members of Congress.

The final NCD establishes specific medical necessity criteria for ventilator use that are expected to influence patient access, reimbursement, and utilization patterns.

In addition to affecting traditional Medicare, the NCD may also influence coverage determinations and reimbursement policies under commercial insurance and Medicare Advantage plans that reference or align with CMS coverage criteria.

These changes may have a material impact on our business.

Monthly rental revenue from ventilators represented approximately 51% and 56%, respectively, of revenue for 2025 and 2024.

Medicare Administrative Contractors responsible for processing durable medical equipment claims have issued LCDs for Respiratory Assist Devices (“RADs”) which contain language describing an overlap in conditions used to determine coverage for RADs and ventilator devices.

These LCDs state that the treatment plan for any individual patient, including the determination to use a ventilator or a BiPAP, may vary and will be made based upon the specifics of each individual beneficiary’s medical condition.

Due to this variability, determinations of coverage for our ventilator products are subject to scrutiny of individual medical records and claims.

Revenues from Medicare and Medicaid accounted for 40% and 43%, respectively, of revenue for the years ended December 31, 2025 and 2024.

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We believe a reduction or elimination of coverage or reimbursement of our products by Medicare would likely cause some commercial third-party payors to implement similar reductions in their coverage or reimbursement of our products.

If we are unable

to expand coverage of our products by additional commercial payors, or if third-party payors that currently cover or reimburse for our products reverse or limit their coverage in the future, our business and results of operations could be adversely affected.

If we are unable to expand coverage of our products by additional commercial payors, or if third-party payors that currently cover or reimburse for our products reverse or limit their coverage in the future, our business and results of operations could be adversely affected.

The respiratory care industry is highly competitive.

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Compared sentence by sentence after normalising whitespace, quotation marks, case and digits, so re-formatting and restated figures do not read as changed language. Wording changes appear as one removal and one addition. The current filing and the prior one are authoritative.

What changed 10-K

Item 1. Business