The Centers for Medicare & Medicaid Services (CMS) is a department of Health and Human Services (HHS). The current administrator is Seema Verma, appointed by President Donald Trump.

CMS oversees the Medicare and Medicaid programs. CMS collects and analyzes data, produces research reports, and works to eliminate instances of fraud, waste and abuse within the health care system.

HHS's Biggest Move in a Decade to Improve Care for Older Adults, People With Disabilities
New Rule Reduces Red Tape and Simplifies Medicare Savings Program Enrollment, Helping Millions of Older Adults and People with Disabilities Afford Coverage

WASHINGTON—The Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), finalized a rule to streamline enrollment in the Medicare Savings Programs (MSPs), making coverage more affordable for an estimated 860,000 people. CMS estimates the improvements will save older adults and people with disabilities nearly 19 million hours in paperwork each year and reduce state administrative burden by more than 2 million hours annually.

CMS Unveils New State Model for Care Management
Model is designed to give states flexibilities in Medicaid, Medicare approaches

WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) unveiled a new payment model that will give states  more flexibilities in how they manage health care, and could ultimately shift focus to home- and community-based services. The States Advancing All-Payer Health Equity Approaches and Development Model (“States Advancing AHEAD” or “AHEAD Model”) aims to better address chronic disease, behavioral health and other medical conditions.

Lincare Pays $29M to Resolve Claims of Overbilling Medicare for Oxygen Equipment
The settlement is the largest-ever health care fraud settlement in the Eastern District of Washington

SPOKANE, Washington—Lincare Holdings, Inc., a Florida-based, wholly-owned subsidiary of German multinational chemical corporation Linde plc, has agreed to pay $29 million and perform extensive corrective actions to resolve allegations that it fraudulently overbilled Medicare and Medicare Advantage Plans for oxygen equipment, announced Vanessa R. Waldref, the United States Attorney for the Eastern District of Washington.

DME Business Operators Charged in $14M Power Wheelchair Fraud Scheme
The 16-count indictment charges the operators with conspiracy to commit health care fraud, aggravated identity theft and money laundering.

BROWNSVILLE, Texas—The operators of a durable medical equipment company have been charged with defrauding Medicare, announced U.S. Attorney Alamdar S. Hamdani.

Authorities took Maria Luisa Yzaguirre, 43, Harlingen, into custody on Aug. 30. Jeremiah Yzaguirre, 44, also of Harlingen, was arrested Aug. 22.  

The 16-count indictment charges the operators with conspiracy to commit health care fraud, aggravated identity theft and money laundering.

Reprise Biomedical’s Miro3D Wound Matrix Granted Level II HCPCS Code by CMS
CMS has assigned HCPCS Level II code A2025, ‘Miro3d, per cubic centimeter,’ to Miro3D

MINNEAPOLIS, Minnesota—Reprise Biomedical, Inc., an innovator in medical biotechnology for wound care, announced the Centers for Medicare and Medicaid Services (CMS) has assigned a Level II Healthcare Common Procedure Coding System (HCPCS) code to its Miro3D wound matrix, effective Oct. 1, 2023.

Florida Man Admits $3.6M Health Care DME Fraud Scheme
Fitchner received kickbacks & bribes in exchange for providing DME companies with completed doctors’ orders for medically unnecessary DME

TRENTON, New Jersey– A Florida man admitted his role in a durable medical equipment (DME) kickback scheme, U.S. Attorney Philip R. Sellinger said.

Patrick Fitchner, 51, of Orlando, Florida, pleaded guilty on Tuesday, Aug. 22 before U.S. District Judge Michael A. Shipp in Trenton federal court to an information charging him with one count of conspiracy to commit health care fraud.

Florida Man Sentenced For Defrauding Medicare of $11M
Anthony Cracchiolo was additionally sentenced to prison for illegally possessing an automatic weapon & 130 rounds of ammunition as a convicted felon

NEW YORK—Damian Williams, the United States Attorney for the Southern District of New York, announced Anthony Cracchiolo was sentenced to five years in prison for conspiring to defraud the Medicare Program and for illegally possessing an automatic weapon as a convicted felon.

CMS Responds to Data Breach at Contractor
CMS notified those potentially involved beneficiaries & providing information on free credit monitoring

WASHINGTON—The Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) have responded to a May 2023 data breach in Progress Software’s MOVEit Transfer software on the corporate network of Maximus Federal Services, Inc. (Maximus), a contractor to the Medicare program, that involved Medicare beneficiaries’ personally identifiable information (PII) and/or protected health information (PHI). No HHS or CMS systems were impacted.

OIG Report Highlights Prior Authorization Denials, Medicaid MCOs
A new report from the HHS Office of Inspector General (OIG) puts a spotlight on potential access issues for patients served by Medicaid Managed Care Organizations (MCOs)

WASHINGTON—A new report from the HHS Office of Inspector General (OIG) puts a spotlight on potential access issues for patients served by Medicaid Managed Care Organizations (MCOs).

The report lists three factors that may be preventing medically necessary care:

NAHC Tells CMS Rate Cuts Hindered Access to Home Health Services
The purpose of the letter is to sound the alarm for CMS about the risks associated with implementing additional rate cuts to Medicare home health.

WASHINGTON—The National Association for Home Care & Hospice (NAHC) and the Partnership for Quality Home Healthcare (the Partnership) submitted a pre-comment letter to the Centers for Medicare & Medicaid Services (CMS) on July 28 warning that the CY 2024 HH PPS Proposed Ru

Bill to Provide Medicare Coverage of Custom Breast Prostheses Reintroduced in Congress
The Breast Cancer Patient Equity Act would provide Medicare coverage of custom breast prostheses to breast cancer survivors

WATERLOO, Iowa—U.S. Representatives Judy Chu (D-CA) and Mariannette Miller-Meeks (R-IA) have reintroduced the bipartisan H.R. 4779: Breast Cancer Patient Equity Act, which would provide Medicare coverage of custom breast prostheses to breast cancer survivors. Since most private insurance companies follow Medicare coverage standards, passage of this legislation would allow hundreds of thousands of women each year to choose a custom prosthesis after a mastectomy.

Telemedicine Owner Charged With $44M Medicare Fraud Scheme
David Santana was charged and agreed to plead guilty in connection with a $44 million telemedicine fraud scheme involving medically unnecessary DME

BOSTON – The owner of Conclave Media (Conclave) and Nationwide Health Advocates (Nationwide) has been charged and has agreed to plead guilty in connection with a $44 million telemedicine fraud scheme involving medically unnecessary durable medical equipment (DME), including orthotics such as back and knee braces and genetic tests. 

AAHC Asks You to Tell Representatives to Join House Sign-On Letter Protecting Access to Oxygen
Reps. Terry Sewell (D-AL) and Adrian Smith (R-NE) are leading an effort to help maintain strong access to home oxygen for individuals with respiratory challenges.

Reps. Terry Sewell (D-AL) and Adrian Smith (R-NE) are leading an effort to help maintain strong access to home oxygen for individuals with respiratory challenges.

CMS Releases Statement on Coverage of Alzheimer's Drug Leqembi

Broader Medicare coverage is now available for Biogen and Eisai’s Leqembi (the brand name for lecanemab) following the Food and Drug Administration’s (FDA) move to grant traditional approval to the drug that treats individuals with Alzheimer’s disease. The Centers for Medicare & Medicaid Services had previously announced this would be the case and released more details on coverage.