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.

Fraud costs Medicare an estimated $60 billion per year

ALBANY, New York—Fraud costs Medicare an estimated $60 billion per year according to the New York StateWide Senior Action Council.

It costs Medicare beneficiaries time, stress, their medical identities and potentially their health. It costs families, friends and caregivers in worry and lost work when helping their loved ones recover from falling victim to Medicare fraud.

Shiva Akula was convicted ton 23 counts in relation to an extensive health care fraud scheme

NEW ORLEANS—U.S. District Judge Lance Africk sentenced Shiva Akula, age 68, of New Orleans, to 240 months of imprisonment, three years of supervised release and $2,300 in mandatory special assessment fees, in relation to an extensive health care fraud scheme orchestrated by Akula. In November 2023, a federal jury convicted Akula of all 23 counts of his underlying indictment.

Jacqueline Saa has a genetic condition that leaves her unable to stand and walk on her own or hold a job. Every weekday for four years, Saa, 43, has relied on a home health aide to help her cook, bathe and dress, go to the doctor, pick up medications, and accomplish other daily tasks.

She received coverage through Florida’s Medicaid program until it abruptly stopped at the end of March, she said.

The bipartisan group demanded answers from CMS on the implementation of recent reforms aimed at combatting hospice fraud & abuse

WASHINGTON—On Wednesday, May 8, Congressman Earl Blumenauer (D-OR) and Congresswoman Beth Van Duyne (R-TX) led a bipartisan group of 38 lawmakers demanding answers from Centers for Medicare & Medicaid Services (CMS) on the implementation of recent reforms aimed at combatting hospice fraud and abuse.

CMS proposes to modify the current three IC HCPCS codes to six HCPCS codes—establishing five new IC codes

WASHINGTON—Last week, the Centers for Medicare & Medicaid Services (CMS) released the 2024 Bi-Annual HCPCS Public Meeting Agenda for May 28-30. The first topic listed in the May 28 Agenda is CMS’s proposal to expand the HCPCS codes list for intermittent catheters (ICs).

Patel was a leader of a scheme which resulted in losses to Medicare of nearly $50 million.

NEW YORK—Damian Williams, the United States Attorney for the Southern District of New York, announced that Manishkumar Patel pled guilty  in connection with a $50 million health care fraud and kickback scheme involving the sale of fraudulent prescriptions for durable medical equipment (DME), among other medical supplies, to suppliers, pharmacies and laboratories who obtained payment for those fraudulent prescriptions from Medicare. Patel pled guilty before U.S. Magistrate Judge Ona T.

CGM suppliers who are recipients of the OIG requests have likely been notified via email

The American Association for Homecare (AAHomecare) reported that last week, the HHS Office of Inspector General (OIG) began sending emails and letters to a select group of continuous glucose monitor (CGM) suppliers as part of an evaluation for its study "Medicare Payments Compared to the Prices Available to Consumers and Suppliers for Continuous Glucose Monitors and Sensors." This study aims to determine the cost-effectiveness of Medicare payments in comparison to the supplier’s acquisition c

More have spoken on the rule which many believe will only add more pressure to already stressed staffing in home- and community-based care.

Since the Centers for Medicare & Medicaid Services (CMS) released its Final Rule on "Ensuring Access to Medicaid Services" on Monday, April 22, many in the industry have voiced their disappointment in the rule, including the National Association for Home Care & H

Actions are the latest in a series of steps the Biden-Harris Administration has taken intending to improve safety, provide support for care workers and family caregivers & to expand access to affordable, high-quality care

WASHINGTON—The Centers for Medicare & Medicaid Services released its Final Rule on "Ensuring Access to Medicaid Services" on Monday, April 22.

The organization said the Final Rule will result in agency closures, force providers to exit the Medicaid program and make access issues overall worse

WASHINGTON—The National Association for Home Care & Hospice (NAHC) released a statement noting that it was, 'extremely disappointed that the Centers for Medicare and Medicaid Services (CMS) elected to finalize the “payment adequacy” provision in the Medicaid Access Final Rule (CMS 2442-F).'

teven Richardson, 40, of Parkland, Florida, pleaded guilty to one count of conspiracy to commit health care fraud

BOSTON—The owner of Expansion Media (Expansion) and Hybrid Management Group (Hybrid) plead guilty on April 3 in connection with a $110 million telemedicine fraud scheme involving medically unnecessary durable medical equipment (DME), including orthotics such as back and knee braces. 

The proposed rule includes a 2.6% payment rate update, regulatory text changes and a proposed implementation of the Hospice Outcomes & Patient Evaluation (HOPE) tool.

WASHINGTON—On March 28, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1810-P) that would update Medicare hospice payments and the aggregate cap amount for fiscal year (FY) 2025 in accordance with existing statutory and regulatory requirements.

This implementation facilitates statewide aggregation of critical health care data aligned with the 21st Century Cures Act

VERLAND PARK, Kansas—Netsmart, a provider of software and services for payers, providers and state Medicaid Agencies, announced the deployment of the Netsmart electronic visit verification (EVV) system for the Montana Department of Public Health & Human Services (DPHHS). This implementation facilitates statewide aggregation of critical health care data aligned with the 21st Century Cures Act.

Andrew Chmiel was sented for a nearly $100 million scheme related to the payment of kickbacks and bribes in exchange for medically unnecessary DME orders

COLUMBIA, South Carolina—Andrew Chmiel, 48, of Mt. Pleasant, was sentenced to nine years in federal prison for his role in a nearly $100 million scheme related to the payment of kickbacks and bribes in exchange for medically unnecessary durable medical equipment (DME) orders.  

Legislation streamlines access to Medicare and Medicaid services for people eligible for both, ensuring older adults’ access to integrated care 

WASHINGTON—U.S. Senators Bill Cassidy, M.D. (R-LA), Tom Carper (D-DE), John Cornyn (R-TX), Mark Warner (D-VA), Tim Scott (R-SC) and Bob Menendez (D-NJ), members of the Senate Duals Working Group, introduced the Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024 to improve coverage for individuals jointly enrolled in Medicare and Medicaid, also known as dual eligibles.

The DUALS Act of 2024:

It was alleged the home health agency violated the False Claims Act by submitting fraudulent claims to Medicaid for reimbursement

CHARLOTTE, North Carolina—Family First Home Health Care, Inc. (Family First), a home health care agency located in Gastonia, North Carolina, (now d/b/a Gaston Piedmont Health Care Inc.), and its owner Marion James have agreed to collectively pay $600,000 to resolve allegations that they knowingly violated the Federal and North Carolina False Claims Acts from Jan. 1, 2015, through Jan. 9, 2020, by submitting thousands of fraudulent claims to Medicaid for reimbursement, announced Dena J.

The pair conspired to commit Medicare fraud by billing for medically unnecessary DME such as knee, ankle, shoulder, wrist and back braces

SAN DIEGO—Anthony Duane Bell Sr. and his son, Anthony Duane Bell Jr., were sentenced in federal court to 65 months and 12 months and one day, respectively, for their roles in fraudulently receiving more than $21 million in Medicare payments and lying to cover it up.