CMS/Medicare

WASHINGTON—Rep. Chris Smith (R-NJ) is spearheading a Congressional sign-on letter to Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz seeking to delay competitive bidding for ostomy and urological supplies.

Delaying implementation of the proposed bidding protocols for these products will allow for a thorough review of serious concerns arising from their potential inclusion in the competitive bidding program, advocates argue.

FLORIDA—A federal jury in the Middle District of Florida convicted the owner of a marketing company, and former NFL player, for his role in a years-long scheme to bilk Medicare and the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) out of nearly $200 million by allegedly selling patient information and sham doctors’ orders for orthotic braces that patients did not want or need.

FORT LAUDERDALE, Florida—A federal jury in Fort Lauderdale, Florida, convicted a nursing assistant for his role in an $11.4 million health care fraud and wire fraud conspiracy in which hundreds of Medicare beneficiaries were allegedly sent thousands of orthotic braces they did not need.

WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) has released a new online complaint form for providers to submit grievances related to Medicare Advantage (MA) plans.

BIRMINGHAM, Michigan—Assured Home Nursing (AHN), a provider on at-home senior care based in Birmingham, Michigan, announced it is officially certified as a Medicaid Home Help provider in the state. 

AHN's services include helping Medicaid eligible seniors and people with disabilities with activities of daily living (ADLs) like bathing and dressing, as well as instrumental activities of daily living (IADLs) like cooking and managing medications.

WASHINGTON—Earlier this week, the Centers for Medicare & Medicaid Services (CMS) updated several lists that cover durable medical equipment (DME) reimbursement authorization. The three lists updated were the required face-to-face and written order prior to delivery list (Required F2F/WOPD), the required prior authorization list and the master list. 

WASHINGTON—The Centers for Medicare & Medicaid Services announced it is expanding the provisional period of enhanced oversight (PPEO) for newly enrolled hospices in Ohio and Georgia. This expansion adds to the list of states that have implemented the PPEO including Arizona, California, Nevada and Texas.

OWINGS MILLS, Maryland—The Centers for Medicare & Medicaid Services (CMS) has reinstated the Board of Certification/Accreditation (BOC) as an approved accrediting organization (AO) for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) until further notice.

WASHINGTON—The Centers for Medicare and Medicaid Services (CMS) held a series of listening sessions hosted by CMS Administrator Dr. Mehmet Oz on home health and hospice fraud in Los Angeles. The sessions were attended by staff of LeadingAge national, LeadingAge California and The National Alliance for Care at Home. 

WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) has halted the ability of the Board of Certification/Accreditation International (BOC) to act as an approved accreditation organization for durable medical equipment (DME) providers. BOC said it was "dismayed" by CMS' actions and that it has filed a lawsuit in U.S. District Court against Secretary of Health and Human Services Robert F. Kennedy Jr. 

NEW YORK—A New York doctor was sentenced to seven years in prison for allegedly causing the submission of over $24 million in fraudulent claims to Medicare for medically unnecessary laboratory tests and orthotic braces. He was also ordered to pay $2,210,384 in restitution.

DALLAS—Homecare Homebase (HCHB), a software provider for home-based care, announced key insights and compliance preparations following the Centers for Medicare & Medicaid Services' (CMS) Calendar Year 2026 Home Health Prospective Payment System final rule. 

WASHINGTON—A wide range of durable medical equipment (DME), including oxygen, mobility and CPAP products, will not be included in the upcoming round of the competitive bidding program, according to an update from the Centers for Medicare & Medicaid Services (CMS). 

WASHINGTON—The Medicare Payment Advisory Commission (MedPAC) released a draft report recommending that Congress reduce the Medicare base payment rate for home health care services for calendar year 2027 by 7%.

The Dept. of Health and Human Services Office of Inspector General (OIG) published a report on continuous glucose monitors (CGMs) and supplies acquisition cost. In the report, "Medicare Payments for Continuous Glucose Monitors and Supplies Exceeded Supplier Costs and Retail Market Prices, Indicating Medicare Can Save At Least Tens of Millions of Dollars in One Year," the OIG recommends that the Centers for Medicare & Medicaid Services (CMS) seek payment reductions for CGMs and supplies.

Along with the occasional aches and pains, growing older can bring surprise setbacks and serious diseases. Longtime relationships with doctors people trust often make even bad news more tolerable. Losing that support — especially during a health crisis — can be terrifying. That’s why little-known federal requirements are supposed to protect people with privately run Medicare Advantage coverage when contract disputes lead their health care providers and insurers to part ways.

WASHINGTON—Sen. Roger Marshall (R-KS) and Sen. Sheldon Whitehouse (D-RI) sent a letter to Senate leadership expressing bipartisan support for policies that preserve the Medicare hospice benefit under Medicare, including for Medicare Advantage (MA) beneficiaries.

WASHINGTON—AdvaMed, a trade association representing medical technology companies, praised a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz urging the agency not to finalize a proposal the lawmakers warned could reduce and complicate patient access to continuous glucose monitors (CGMs) and durable insulin pumps.