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.
PHOENIX, Arizona—Banner Alzheimer’s Institute and Banner Sun Health Research Institute were selected by the Centers for Medicare & Medicaid Services (CMS) to participate in a new Medicare alternative payment model designed to support people living with dementia and their caregivers.
NASHVILLE—United States Attorney Henry C. Leventis announced criminal charges against four defendants in connection with alleged schemes to defraud Medicare. The charges stem from schemes to bill Medicare for medically unnecessary genetic tests, durable medical equipment, and medications that were procured through kickbacks used to obtain doctors’ orders and patient information.
The following individuals have been charged in the Middle District of Tennessee:
NEWARK, New Jersey – A Georgia chiropractor who owned or operated multiple durable medical equipment (DME) companies and a cancer genetic testing (CGx) company admitted her role in a health care fraud and illegal kickback conspiracy, Attorney for the United States Vikas Khanna announced.
WASHINGTON—On June 28, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the proposed rule entitled, “Medicare Program: Mitigating the Impact of Significant, Anomalous, and Highly Suspect Billing Activity on Medicare Shared Savings Program Financial Calculations in Calendar Year 2023” (CMS-1799-P).
MONROE, Lousiana—United States Attorney Brandon B. Brown announced that criminal charges have been filed against a West Monroe man in connection with an alleged durable medical equipment (DME) scheme to defraud Medicare. The charges filed in federal court are part of the Department of Justice’s 2024 National Health Care Fraud Enforcement Action.
TAMPA, Florida—United States Attorney Roger B. Handberg announced criminal charges against nine individuals in connection with alleged schemes to defraud programs entrusted for the care of the elderly and disabled, and to obtain controlled substances through fraud. The charges filed in the Middle District of Florida (MDFL) are part of the Department of Justice’s 2024 National Health Care Fraud Enforcement Action.
WASHINGTON—The Department of Justice (DOJ) announced the United States has settled a civil fraud lawsuit against VNS Health, Visiting Nurse Service of New York Home Care and VNS Health Behavioral Health (collectively VNS) for $1 million.
WASHINGTON—Following its early June decision to file to join the American Health Care Association’s (AHCA) lawsuit against the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS), LeadingAge, the association of nonprofit providers of aging services, including nursing homes, announced its official co-plaintiff status.
PROVIDENCE, Rhode Island—Rhode Island’s homecare providers are celebrating this evening’s passage of the state’s fiscal year 2025 (SFY25) budget set to begin on July 1, 2024. Within Article 9 of the budget, the Rhode Island General Assembly (state legislature) approved significant Medicaid fee-for-service rate increases for contracted homecare provider companies. These rate increases include some that are higher than 75% effective Oct. 1, 2024.
LOS ANGELES—Five individuals were arrested in Los Angeles on criminal charges related to their roles in a years-long scheme to defraud Medicare of more than $15 million through sham hospice companies and then to launder the fraud proceeds.
CINCINNATI, Ohio—Sharon Romaine Ward, 52, formerly of West Chester, pleaded guilty in U.S. District Court to fraudulently billing more than $8.5 million to Medicare, Medicaid and Veterans Affairs home health care programs between 2015 and 2021.
WASHINGTON—House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) and Subcommittee on Health Chair Brett Guthrie (R-KY) announced a subcommittee hearing titled “Checking-In on CMMI: Assessing the Transition to Value-Based Care.”
WASHINGTON & ALEXANDRIA, Virginia—The National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO) responded to the Centers for Medicare & Medicaid Services (CMS) recently revised guidance regarding the implementation of the hospice certifying physician enrollment requirement.
NEWARK, New Jersey—A Florida man was sentenced to 96 months in prison for his role in a multimillion-dollar durable medical equipment (DME) kickback scheme, Attorney for the United States Vikas Khanna, District of New Jersey, and U.S. Attorney Markenzy Lapointe, Southern District of Florida, announced today.
CGS shared guidance on billing wheelchair electronics to DME MAC Jurisdiction B and Jurisdiction C pages. Power Wheelchair Electronics Clarification, published on May 30, is a step in the right direction of providing clear coverage guidelines for Medicare, the American Association for Homecare said.
MIAMI—A Miami federal district judge sentenced a fugitive to 87 months in prison followed by three years of supervised release for his role in a multimillion-dollar conspiracy to commit money laundering. The judge also ordered him to pay $3,709,860 in restitution.
NEW YORK—A U.S. District Attorney in New York state announced the settlement of a civil fraud lawsuit against Riverspring Living Holding Corp. and Elderserve Health, Inc., two not-for-profit corporations that run a managed long-term care plan (MLTCP) for Medicaid beneficiaries.
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.
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.
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.
LEXINGTON, Kentucky—A Lexington doctor, Amr Mohamed, 55, was sentenced by U.S. District Judge Karen Caldwell to two years in prison for a kickback conspiracy.
