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 Centers for Medicare & Medicaid Services (CMS) has added eight HCPCS codes to the list of those requring prior authorization for Medicare billing, including a bed, a wheelchair and several orthoses.
WASHINGTON—The United States Department of Health and Human Services Office of Inspector General (OIG) recently determined that there is more that could be done by the Centers for Medicare & Medicaid Services to prevent durable medical equipment, prosthetics and orthotics supplies (DMEPOS) fraud in Medicare Advantage.
WATERLOO, Iowa—VGM Insurance announced that it is ready to provide the $100,000 bid surety bond required by the Centers for Medicare & Medicaid Services (CMS) for the upcoming durable medical equipment, prosthetics and orthotics supplies competitive bidding program round in 2028.
The company said this offering gives home medical equipment (HME) and orthotic and prosthetic (O&P) suppliers the support they need to participate in the next round of bidding with confidence.
WASHINGTON—A new survey from the American Association for Homecare (AAHomecare) captured the real-world impact of the 2021 remote item delivery competitive bidding program round. The findings showed that the planned 2028 round would threaten patient access to care and products on a national scale, lead to large layoffs and pose a serious threat to business survival.
WASHINGTON—Centers for Medicare & Medicaid Services (CMS) announced it has identified and is barring 11 medical supply companies with more than $3.4 billion in suspected fraudulent billing practices in 2025 and 2026 from receiving future Medicare Advantage (MA) Part C and Part D payments.
These 11 durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) suppliers allegedly:
WASHINGTON—In a joint sign-on letter led by LeadingAge, a coalition of 19 partners representing hospitals, physician and clinician practices, post-acute and long-term care providers, home health and hospice agencies and suppliers warned the Centers for Medicare & Medicaid Services (CMS) that changes to Medicare provider enrollment provisions included in the proposed payment rule for home health risk penalizing legitimate providers and could result in limiting beneficiary access to care.&n
ALEXANDRIA, Virginia—While next year's planned home health Medicare rates do include a welcome full annual payment update, the overall proposed rule doesn't do enough to undo prior harm or protect access to care across the country, the National Alliance for Care at Home said in public comments on the rule.
WASHINGTON—The temporary six-month moratorium on durable medical equipment (DME) supplier enrollment in Medicare ended on Aug. 27, the Centers for Medicare & Medicaid Services announced.
NASHVILLE, Tennessee—Monogram Health Professional Services PC and Monogram Health Inc., headquartered in Tennessee, have agreed to pay $2.4 million to resolve allegations that they violated the False Claims Act by causing the submission of false diagnosis codes to increase payments that they received from the Medicare Advantage program.
WASHINGTON—In a recently published report, the Department of Health and Human Services Office of Inspector General (OIG) said the Centers for Medicare & Medicaid Services (CMS) should take "bold action" to prevent durable medical equipment (DME) fraud, making recommendations that include tightening Medicaid enrollment for providers, collaborating with physicians and using new technologies like AI.
WASHINGTON—A new study by KFF analyzes the issues and scrutiny surrounding the use of prior authorizations by insurance companies.
Health insurers use prior authorization to reduce the use of low-value or unnecessary care. However, many individuals report this practice may result in delays or denials in receiving necessary care, as well as administrative burdens for patients and providers.
WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) released additional guidance on Round 2028 of the competitive bid program for durable medical equipment, and also announced the expected number of contract awards for the first tie, according to the American Association for Homecare. They are:
WASHINGTON—Newly introduced bicameral legislation aims to establish long-term care services benefits as part of the Medicare program. The Medicare At Home Act (HR 10020/S 5270) would help older adults and people with disabilities remain safely in their homes and communities by expanding homecare coverage under Medicare Part B.
WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) announced additional resources and flexibilities available in response to a public health emergency (PHE) in Washington state due to emergency conditions resulting from major wildfires, including the Fairview, Autumn Lane and Old Trails fires near Spokane County beginning Aug.1.
WASHINGTON—The National Partnership for Healthcare and Hospice Innovation (NPHI) has submitted to the Centers for Medicare & Medicaid Services (CMS) and shared with state Medicaid directors a comment letter urging policymakers and regulators to ensure that individuals receiving hospice and palliative care services are explicitly exempt from Medicaid community engagement requirements during implementation of CMS’s interim final rule (CMS-2454-IFC).
WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) released updates to the Required Face-to-Face and Written Order Prior to Delivery List, Required Prior Authorization List and Master List.
According to a newsletter from the American Association for Homecare (AAHomecare), there are a total of three lists that suppliers should be aware of:
PHILADELPHIA—Twelve individuals and an agency have been charged by federal indictment and additional defendants have been charged by the Pennsylvania Office of Attorney General with healthcare fraud and other offenses, for allegedly conspiring to defraud the Pennsylvania Medicaid program.
CUSHING, Oklahoma—A federal jury in the Middle District of Florida convicted Mark Loftis, 39, an Oklahoma business owner and chiropractor for his role in a years-long scheme that attempted to bilk Medicare, TRICARE and the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) out of more than $30 million.
MIAMI—Michael Kochen, 42, of Aventura, Florida, and Sandro Herek, 56, of Coral Springs, Florida, Two South Florida men, a healthcare executive and a telemarketing company owner, have been sentenced to federal prison for their alleged roles in a Medicare Advantage scheme.
WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) issued a final rule that would increase Medicare hospice payments and the aggregate cap amount for fiscal year 2027 under existing statutory and regulatory requirements.
TRENTON, New Jersey—Legislation introduced in the state of New Jersey aims to ease regulatory burdens on home healthcare providers.
Bill S 3463 would make the following changes to existing law:
