CMS/Medicare

FLORIDA—Last week, the Florida American Health Care Association (AHCA) released its updated durable medical equipment (DME) Medicaid fee schedule based on state budget legislation that provided the first broad-scope DME reimbursement increase in 23 years, the American Association for Homecare (AAHC) said.

ATLANTA—A Texas man and owner of two durable medical equipment (DME) companies has pleaded guilty to conspiracy for his role in a scheme to pay illegal kickbacks, resulting in more than $20 million submitted in claims to, and $11 million in payment from, Medicare.

ATLANTA—Brett Weiner and Valerie Desalvo have pled guilty to federal conspiracy charges for their role in buying and selling fake doctors’ orders used to obtain over $1.5 million in fraudulent payments from Medicare.

WASHINGTON—On Monday, Nov. 6, the Biden-Harris Administration proposed steps to fix Medicare Advantage's (MA) use of prior authorization as well as curb predatory marketing within MA plans.

NEWARK, New Jersey—The owner of a marketing company located in India admitted his role in conspiracies to commit healthcare fraud and to pay and receive illegal kickbacks, Attorney for the United States Vikas Khanna announced.

PELHAM MANOR, New York—Damian Williams, the United States Attorney for the Southern District of New York, and Naomi Gruchacz, the Special Agent in Charge of the New York Office of the U.S. Department of Health and Human Services, Office of Inspector General (“HHS-OIG”), announced the unsealing of a five-count Indictment charging Manishkumar Patel in connection with a health care fraud and kickback scheme involving the sale of fraudulent prescriptions.

WASHINGTON—The Justice Department announced charges against a former executive at HealthSun Health Plans Inc. (HealthSun)—a Medicare Advantage organization that operates Medicare Advantage plans in South Florida—for her role in a multimillion-dollar Medicare fraud scheme. 

WASHINGTON— In what was called a "big win" by the American Association for Homecare (AAHomecare) the Centers for Medicare & Medicaid Services (CMS) published a change request (CR) directing DME MACs to adjust their local edits to allow for 90-day billing for continuous glucose monitor (CGM) supplies to align with blood glucose monitor supplies.

LEXINGTON, Kentucky—Oxygen Plus, Inc., a provider of durable medical equipment (DME) based in Floyd County, Kentucky, has agreed to pay $200,000 to resolve allegations that it violated the False Claims Act by fraudulently billing Medicare and Medicaid for respiratory devices that patients did not need or use, in contravention of those programs’ requirements.

MIAMI—A federal jury in Miami convicted a Florida man and woman for their roles in a conspiracy to defraud Medicare by billing more than $93 million for home health therapy services that were never rendered.

WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) announced that beginning Monday, Oct. 9, 2023, all durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) provider enrollment appeals and rebuttals should be sent to 

MICHIGAN—A federal jury in the Eastern District of Michigan convicted Yogesh Pancholi for orchestrating a $2.8 million health care fraud and wire fraud conspiracy and engaging in money laundering, aggravated identity theft and witness tampering.

BOSTON—The owner of Conclave Media (Conclave) and Nationwide Health Advocates (Nationwide) pleaded 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. 

WASHINGTON—On Tuesday, Sept.

MIAMI—A defendant, who was previously convicted of money laundering, was sentenced to a total of 90 months in federal prison for his recent money laundering conviction. 

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.

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.

The Centers for Medicare & Medicaid Services (CMS) released an announcement on efforts to support Florida’s emergency response to Hurricane Idalia, including resources and flexibi

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.