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.
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.
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.
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.
A Southern California man pleaded guilty to submitting false enrollment applications to Medicare that hid the real owners of a fraudulent hospice company, which then submitted over $3.1 million in false and fraudulent claims to Medicare.
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.
HOUSTON—Two Houston residents—Caroline Zamora, 63, and Rommel Zmora, 59—are set to appear on allegations in an $8.7 million fraud scheme connected to a home health company they jointly owned and operated, announced U.S. Attorney Alamdar S. Hamdani.
HOUSTON—A 63-year-old Sugar Land resident has been ordered to prison for conspiracy to pay and receive kickbacks, announced U.S. Attorney Alamdar S. Hamdani.
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.
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).
HOUSTON – A 43-year-old Houston woman has been charged for conspiracy to commit and committing health care fraud, announced U.S. Attorney Alamdar S. Hamdani on Friday, March 10.
Rose Davies is expected to make her initial appearance before U.S. Magistrate Judge Dena H. Palermo.
A federal grand jury returned a six-count indictment March 1 against Davies.
LOS ANGELES— AppliedVR, an immersive therapeutics (ITx) company, announced the Centers for Medicare and Medicaid Services (CMS) established a unique Healthcare Common Procedure Coding System (HCPCS) Level II code (E1905) for its flagship product, the RelieVRx program.
Washington, D.C.—U.S. Senator Bob Casey (D-PA) joined 21 Senators in a request to the Biden Administration to publicize the effect of the Inflation Reduction Act’s Medicare Part B inflation rebate on coinsurance in the program.
Washington, D.C.—A new bill has been introduced in Congress that would increase Medicaid and state funding for home- and community-based services (HCBS) and provide resources to states for the caregiving workforce.
Supporters say the HCBS Access Act would, over time, eliminate lengthy waiting lists for homecare services.
The Centers for Medicare & Medicaid Services (CMS) released a proposed national coverage determination (NCD) decision that would, for the first time, expand coverage for power seat elevation equipment on certain power wheelchairs to Medicare individuals. The proposed NCD is open for public comment for 30 days.
WASHINGTON—The COVID-19 public health emergency (PHE) will end May 11, and with it a range of waivers and regulatory changes that have benefited the homecare industry.
WASHINGTON (December 13, 2022)—The federal system meant to stop health care business owners and executives from repeatedly bilking government health programs fails to do so, a Kaiser Health News (KHN) investigation has found.
That means people are once again tapping into Medicaid, Medicare, and other taxpayer-funded federal health programs after being legally banned because of fraudulent or illegal behavior.
WASHINGTON (December 7, 2022)—The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that it says would improve interoperability and streamline processes related to prior authorization for medical items and services.
