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.

Man Sentenced to 65 Months in Prison for Defrauding Medicare Of $7M
Margait engaged in a scheme to defraud Medicare by illegally obtaining and selling fraudulent orders for DME paid for by Medicare.

Damian Williams, the United States Attorney for the Southern District of New York, announced that Christopher Margait was sentenced to 65 months in prison for conspiracy to commit health care fraud by fraudulently trafficking in orders for durable medical equipment (DME) such as back, knee, and wrist braces. Margait previously pled guilty to the charge and was sentenced before United States District Judge Denise Cote.

Mountain Empire PACE Signs with TRHC for Expanded Services
TRHC's comprehensive pharmacy services provide Mountain Empire PACE with individualized medication risk management, round-the-clock support, medication delivery and adherence packaging.

MOORESTOWN, New Jersey—Tabula Rasa HealthCare, Inc. (TRHC), a health care company advancing personalized, comprehensive care for value-based care organizations, announced Mountain Empire PACE, a Program of All-Inclusive Care for the Elderly (PACE) in rural Virginia, signed agreements with TRHC for personalized pharmacy services and pharmacy benefit management, expanding their existing partnership.

In Wheelchair Win, CMS OKs Power Seat Elevation for Power Chairs
Calling it a "landmark decision,"CMS announced it had, for the first time, made power seat elevation for power wheelchairs eligible for reimbursement as DME.

WASHINGTON—Calling it a "landmark decision," the Centers for Medicare & Medicaid Services (CMS) announced May 16, 2023 that it had, for the first time, made power seat elevation for power wheelchairs eligible for reimbursement as durable medical equipment (DME). 

Addus Raises on Concerns Over New HHS Proposed Rule
The proposed rule has a stated goal of improving access to services for Medicaid beneficiaries

FRISCO, Texas—Addus HomeCare Corporation, a provider of home care services, commented on the proposed new rule announced last week by the Biden Administration’s Department of Health and Human Services (HHS) known as “Assuring Access to Medicaid Services.” The proposed rule is in addition to those adopted under the Obama Administration in 2016 and incorporates new requirements covering additional Medicaid Services, including home- and community-based services (HCBS).

Man Sentenced to 60 Months For Defrauding Medicare Of $8M Through Claims for DME
Witkowski fraudulently trafficked in orders for durable medical equipment (DME) such as back, knee and elbow braces.

NEW YORK—Damian Williams, the United States Attorney for the Southern District of New York, announced Matthew Taylor Witkowski was sentenced to 60 months in prison for conspiracy to commit health care fraud by fraudulently trafficking in orders for durable medical equipment (DME) such as back, knee and elbow braces. Witkowski previously pled guilty to the conspiracy charge and was sentenced before United States District Judge Denise L. Cote.

Florida Man Sentenced to 9 Years for $48M International Health Care Fraud Scheme
Srivastav used doctors orders to obtain more than $48 million in fraudulent payments from Medicare.

ATLANTA – Nagaindra Srivastav has been sentenced on conspiracy and kickback charges for his role in selling fraudulent doctors’ orders to his co-conspirators who used the orders to obtain more than $48 million in fraudulent payments from Medicare. 

Former Hospice Care Owner Convicted of Defrauding Medicare of $1.5M
The fraudulent claims submitted to Medicare and reimbursed to Angel Care resulted in a loss of approximately $1,539,161.10 to Medicare.

LAFAYETTE, Louisiana–A federal jury has returned a guilty verdict against Kristal Glover-Wing, 50, of Broussard, Louisiana, for one count of conspiracy to commit health care fraud and three counts of health care fraud following a trial that lasted nearly four weeks, announced United States Attorney Brandon B. Brown. Dr. Gary M. Wiltz and Dr. Charles H. Louis were each acquitted on their charges in the indictment. Judge Robert R. Summerhays presided over the trial.

CMS Grants Concurrent Hospice Care With VBID Extension
The extension also grants health plans the ability to restrict MAOs from using out-of-network providers.

Hospice patients will be able to receive concurrent care with Medicare Advantage as the Centers for Medicare and Medicaid Services (CMS) extended its Value-Based Insurance Design for calendar years 2025 through 2030. The extension also grants health plans the ability to restrict Medicare Advantage Organizations (MAOs) from using out-of-network providers in 2026.

HHS Updates 2024 Medicare Advantage Program and Part D Payment Policies
CMS will phase in certain updates, and on average, CMS said it anticipates a payment increase for MA plans of 3.32%

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), released the Calendar Year (CY) 2024 Medicare Advantage (MA) and Part D Rate Announcement that finalized payment policies for these programs. According to HHS, the final policies in the Rate Announcement aim to improve payment accuracy and ensure taxpayer dollars are well spent.

CMS Holds Stakeholder Meeting to Discuss 2023 Home Health Rate Changes
NAHC critiqued CMS's attempt to communicate to stakeholders about the payment rates

Washington, D.C.—In response to a requirement of the Consolidated Appropriations Act (CAA), 2023, the Centers for Medicare & Medicaid Services (CMS) presented data used to determine Medicare home health payment rates for calendar year (CY) 2023, including the permanent and temporary rate adjustments calculated under the Patient Driven Groupings Model (PDGM) “budget neutrality” requirements.

NHIA Secures New Home Infusion Service HCPCS Code for Injectable Immunotherapies

ALEXANDRIA, Virginia—The National Home Infusion Association (NHIA) announced it successfully petitioned the Centers for Medicare and Medicaid Services (CMS) to secure a new billing code for injectable immunotherapies and revise an existing code to facilitate administration of a wider range of monoclonal antibodies for Respiratory Syncytial Virus (RSV).