CMS

In a newsletter, AAHomecare (AAHC) announced it and the ALS Association met with the Centers for Medicare & Medicaid Services (CMS) Part C leadership to share concerns about ongoing authorization challenges for medically necessary non-invasive ventilator (NIV) devices by Medicare Advantage (MA) payers. Access to these ventilator systems is especially important for individuals with significant neuromuscular diseases such as ALS.

The Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary released projections of National Health Expenditures (NHE) and health insurance enrollment for the years 2022-2031.

HOUSTON—A 47-year-old home health company owner has been ordered to prison following his conviction of conspiracy to commit health care fraud, announced U.S. Attorney Alamdar S. Hamdani.

Akintunde Oyewale, Richmond, pleaded guilty Feb. 1, 2022.

Damian Williams, the United States Attorney for the Southern District of New York, announced that Christopher Margait was sentenced to 65 months in prison for conspiracy to commit health care fraud by fraudulently trafficking in orders for durable medical equipment (DME) such as back, knee, and wrist braces. Margait previously pled guilty to the charge and was sentenced before United States District Judge Denise Cote.

MOORESTOWN, New Jersey—Tabula Rasa HealthCare, Inc. (TRHC), a health care company advancing personalized, comprehensive care for value-based care organizations, announced Mountain Empire PACE, a Program of All-Inclusive Care for the Elderly (PACE) in rural Virginia, signed agreements with TRHC for personalized pharmacy services and pharmacy benefit management, expanding their existing partnership.

WASHINGTON—Calling it a "landmark decision," the Centers for Medicare & Medicaid Services (CMS) announced May 16, 2023 that it had, for the first time, made power seat elevation for power wheelchairs eligible for reimbursement as durable medical equipment (DME). 

KFF reported that data released from the Centers for Medicare & Medicaid Services (CMS), shows Medicare Advantage (MA) now provides Medicare coverage for more than half of its eligible beneficiaries. 

The Centers for Medicare & Medicaid Services (CMS) published the much-anticipated Frequently Asked Questions (FAQ) that provides some directions on the ending of the COVID-19 Public Health Emergency (PHE).

AUSTIN, Texas—Oracle announced Seema Verma has been named senior vice president and general manager, Life Sciences. In this role, she will lead the Oracle Life Sciences and Oracle Cerner Enviza lines of business.

NEW YORK—Damian Williams, the United States Attorney for the Southern District of New York, announced Matthew Taylor Witkowski was sentenced to 60 months in prison for conspiracy to commit health care fraud by fraudulently trafficking in orders for durable medical equipment (DME) such as back, knee and elbow braces. Witkowski previously pled guilty to the conspiracy charge and was sentenced before United States District Judge Denise L. Cote.

WASHINGTON—The U.S. Department of Health and Human Services (HHS) announced it is releasing ownership data for all Medicare-certified hospice and homecare agencies. For the first time, anyone can now review detailed information on the ownership of more than 6,000 hospices and 11,000 home health agencies certified to participate in the Medicare program on the Centers for Medicare & Medicaid Services (CMS) website.

Spring House, PENNSYLVANIA—The Compliance Team (TCT), a Centers for Medicare & Medicaid Services (CMS)-approved national healthcare accreditation organization, announced a new accreditation program for Local Health Departments (LHDs).

ATLANTA – Nagaindra Srivastav has been sentenced on conspiracy and kickback charges for his role in selling fraudulent doctors’ orders to his co-conspirators who used the orders to obtain more than $48 million in fraudulent payments from Medicare. 

Hospice patients will be able to receive concurrent care with Medicare Advantage as the Centers for Medicare and Medicaid Services (CMS) extended its Value-Based Insurance Design for calendar years 2025 through 2030. The extension also grants health plans the ability to restrict Medicare Advantage Organizations (MAOs) from using out-of-network providers in 2026.

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), released the Calendar Year (CY) 2024 Medicare Advantage (MA) and Part D Rate Announcement that finalized payment policies for these programs. According to HHS, the final policies in the Rate Announcement aim to improve payment accuracy and ensure taxpayer dollars are well spent.

HOUSTON—A 63-year-old Sugar Land resident has been ordered to prison for conspiracy to pay and receive kickbacks, announced U.S. Attorney Alamdar S. Hamdani.

Washington, D.C.—In response to a requirement of the Consolidated Appropriations Act (CAA), 2023, the Centers for Medicare & Medicaid Services (CMS) presented data used to determine Medicare home health payment rates for calendar year (CY) 2023, including the permanent and temporary rate adjustments calculated under the Patient Driven Groupings Model (PDGM) “budget neutrality” requirements.

ALEXANDRIA, Virginia—The National Home Infusion Association (NHIA) announced it successfully petitioned the Centers for Medicare and Medicaid Services (CMS) to secure a new billing code for injectable immunotherapies and revise an existing code to facilitate administration of a wider range of monoclonal antibodies for Respiratory Syncytial Virus (RSV).

LOS ANGELES— AppliedVR, an immersive therapeutics (ITx) company, announced the Centers for Medicare and Medicaid Services (CMS) established a unique Healthcare Common Procedure Coding System (HCPCS) Level II code (E1905) for its flagship product, the RelieVRx program.