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.
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.
WASHINGTON—Last week, the Centers for Medicare & Medicaid Services (CMS) released the 2024 Bi-Annual HCPCS Public Meeting Agenda for May 28-30. The first topic listed in the May 28 Agenda is CMS’s proposal to expand the HCPCS codes list for intermittent catheters (ICs).
NEW YORK—Damian Williams, the United States Attorney for the Southern District of New York, announced that Manishkumar Patel pled guilty in connection with a $50 million health care fraud and kickback scheme involving the sale of fraudulent prescriptions for durable medical equipment (DME), among other medical supplies, to suppliers, pharmacies and laboratories who obtained payment for those fraudulent prescriptions from Medicare. Patel pled guilty before U.S. Magistrate Judge Ona T.
The American Association for Homecare (AAHomecare) reported that last week, the HHS Office of Inspector General (OIG) began sending emails and letters to a select group of continuous glucose monitor (CGM) suppliers as part of an evaluation for its study "Medicare Payments Compared to the Prices Available to Consumers and Suppliers for Continuous Glucose Monitors and Sensors." This study aims to determine the cost-effectiveness of Medicare payments in comparison to the supplier’s acquisition c
Since the Centers for Medicare & Medicaid Services (CMS) released its Final Rule on "Ensuring Access to Medicaid Services" on Monday, April 22, many in the industry have voiced their disappointment in the rule, including the National Association for Home Care & H
WASHINGTON—The Centers for Medicare & Medicaid Services released its Final Rule on "Ensuring Access to Medicaid Services" on Monday, April 22.
WASHINGTON—The National Association for Home Care & Hospice (NAHC) released a statement noting that it was, 'extremely disappointed that the Centers for Medicare and Medicaid Services (CMS) elected to finalize the “payment adequacy” provision in the Medicaid Access Final Rule (CMS 2442-F).'
BOSTON—The owner of Expansion Media (Expansion) and Hybrid Management Group (Hybrid) plead guilty on April 3 in connection with a $110 million telemedicine fraud scheme involving medically unnecessary durable medical equipment (DME), including orthotics such as back and knee braces.
WASHINGTON—On March 28, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1810-P) that would update Medicare hospice payments and the aggregate cap amount for fiscal year (FY) 2025 in accordance with existing statutory and regulatory requirements.
WASHINGTON—The Centers for Medicare & Medicaid Services announced that the next Home Health, Hospice & DME Open Door Forum is scheduled for Wednesday, April 3, 2024, from 2-3:00 p.m. Eastern Time (ET).
Log on at least 15 minutes prior to the forum start time. The agenda is subject to change.
VERLAND PARK, Kansas—Netsmart, a provider of software and services for payers, providers and state Medicaid Agencies, announced the deployment of the Netsmart electronic visit verification (EVV) system for the Montana Department of Public Health & Human Services (DPHHS). This implementation facilitates statewide aggregation of critical health care data aligned with the 21st Century Cures Act.
COLUMBIA, South Carolina—Andrew Chmiel, 48, of Mt. Pleasant, was sentenced to nine years in federal prison for his role in a nearly $100 million scheme related to the payment of kickbacks and bribes in exchange for medically unnecessary durable medical equipment (DME) orders.
By Phil Galewitz and Holly K. Hacker
Billy Abbott, a retired Army medic, wakes at 6 a.m. every morning, steps on the bathroom scale, and uses a cuff to take his blood pressure.
