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.
NEW YORK—Damian Williams, the United States Attorney for the Southern District of New York, announced Anthony Cracchiolo was sentenced to five years in prison for conspiring to defraud the Medicare Program and for illegally possessing an automatic weapon as a convicted felon.
WASHINGTON—The Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) have responded to a May 2023 data breach in Progress Software’s MOVEit Transfer software on the corporate network of Maximus Federal Services, Inc. (Maximus), a contractor to the Medicare program, that involved Medicare beneficiaries’ personally identifiable information (PII) and/or protected health information (PHI). No HHS or CMS systems were impacted.
WASHINGTON—A new report from the HHS Office of Inspector General (OIG) puts a spotlight on potential access issues for patients served by Medicaid Managed Care Organizations (MCOs).
The report lists three factors that may be preventing medically necessary care:
WASHINGTON—The National Association for Home Care & Hospice (NAHC) and the Partnership for Quality Home Healthcare (the Partnership) submitted a pre-comment letter to the Centers for Medicare & Medicaid Services (CMS) on July 28 warning that the CY 2024 HH PPS P
WASHINGTON—The Biden-Harris Administration said it is taking further action on its commitment to promote care and support for people with Medicare living with dementia and their unpaid caregivers. The U.S.
WATERLOO, Iowa—U.S. Representatives Judy Chu (D-CA) and Mariannette Miller-Meeks (R-IA) have reintroduced the bipartisan H.R. 4779: Breast Cancer Patient Equity Act, which would provide Medicare coverage of custom breast prostheses to breast cancer survivors. Since most private insurance companies follow Medicare coverage standards, passage of this legislation would allow hundreds of thousands of women each year to choose a custom prosthesis after a mastectomy.
BOSTON – The owner of Conclave Media (Conclave) and Nationwide Health Advocates (Nationwide) has been charged and has agreed to plead 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.
FLORIDA—Two Florida men pleaded guilty for their roles in a scheme to defraud Medicare by submitting more than $67 million in false claims for genetic testing and durable medical equipment (DME) that patients did not need and that the defendants procured with kickbacks.
The pleas came after four days of trial in the Southern District of Florida.
Reps. Terry Sewell (D-AL) and Adrian Smith (R-NE) are leading an effort to help maintain strong access to home oxygen for individuals with respiratory challenges.
BOSTON—Senator Edward J.
Broader Medicare coverage is now available for Biogen and Eisai’s Leqembi (the brand name for lecanemab) following the Food and Drug Administration’s (FDA) move to grant traditional approval to the drug that treats individuals with Alzheimer’s disease. The Centers for Medicare & Medicaid Services had previously announced this would be the case and released more details on coverage.
BOSTON—Myomo, Inc. (NYSE American: MYO), a wearable medical robotics company that offers increased functionality for those suffering from neurological disorders and upper-limb paralysis, announced that its request to the Centers for Medicare and Medicaid Services (CMS) to classify the company’s MyoPro as a brace has been published for public comment.
LOS ANGELES—A South Bay woman was found guilty on Tuesday, June 27 of nearly two dozen felonies for billing Medicare more than $24 million by submitting fraudulent claims for medically unnecessary durable medical equipment—mostly power wheelchairs (PWC)—and PWC repairs, many of which were never performed.
The National Association for Home Care & Hospice (NAHC) and the Partnership for Quality Home Healthcare (the Partnership) commended Senators Debbie Stabenow (D-MI) and Susan Collins (R-ME) for introducing the Preserving Access to Home Health Act of 2023 to safeguard access to essential home-based, clinically advanced health care services by preventing the Centers for Medicare & Medicaid Services (CMS) from implementing dire cuts of negative -7.85% to the Medicare Home Health
In a newsletter, AAHomecare (AAHC) announced it and the ALS Association met with the Centers for Medicare & Medicaid Services (CMS) Part C leadership to share concerns about ongoing authorization challenges for medically necessary non-invasive ventilator (NIV) devices by Medicare Advantage (MA) payers. Access to these ventilator systems is especially important for individuals with significant neuromuscular diseases such as ALS.
The Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary released projections of National Health Expenditures (NHE) and health insurance enrollment for the years 2022-2031.
WASHINGTON—U.S. Sens. Mark R. Warner (D-VA) and Tim Scott (R-SC) joined by U.S. Reps.
The Committee on Veterans’ Affairs wrote in a report on its website detailing the ongoing progression of expanding the Veteran Directed Care program to all VA medical centers. Additionally, it addressed nursing home staffing shortage concerns.
CHARLESTON, South Carolina—Deeana Burr, 54, of Charleston, South Carolina, has pleaded guilty to conspiracy to commit health care fraud.
HOUSTON—A 47-year-old home health company owner has been ordered to prison following his conviction of conspiracy to commit health care fraud, announced U.S. Attorney Alamdar S. Hamdani.
Akintunde Oyewale, Richmond, pleaded guilty Feb. 1, 2022.
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.
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.
