CONCORD, New Hampshire—Elis Urena De Cruz, age 42, of Manchester, New Hampshire, has been convicted and sentenced for theft of New Hampshire Medicaid funds, said Attorney General John M. Formella.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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:
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
WASHINGTON—The Biden-Harris Administration said it is taking further action on its commitment to promote care and support for people with Medicare living with dementia and their unpaid caregivers. The U.S.
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.
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.
FLORIDA—Two Florida men pleaded guilty for their roles in a scheme to defraud Medicare by submitting more than $67 million in false claims for genetic testing and durable medical equipment (DME) that patients did not need and that the defendants procured with kickbacks.
The pleas came after four days of trial in the Southern District of Florida.
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.
BOSTON—Senator Edward J.
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.
BOSTON—Myomo, Inc. (NYSE American: MYO), a wearable medical robotics company that offers increased functionality for those suffering from neurological disorders and upper-limb paralysis, announced that its request to the Centers for Medicare and Medicaid Services (CMS) to classify the company’s MyoPro as a brace has been published for public comment.
LOS ANGELES—A South Bay woman was found guilty on Tuesday, June 27 of nearly two dozen felonies for billing Medicare more than $24 million by submitting fraudulent claims for medically unnecessary durable medical equipment—mostly power wheelchairs (PWC)—and PWC repairs, many of which were never performed.