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.
CMS
WASHINGTON—The Center for Medicare & Medicaid Services' proposed 2024 rule for the home health payment system includes a slew of hospice-specific provisions, many of them designed to reduce fraud and so-called "hospice flipping." Here's a look at what's included, according to the National Association for Homecare and Hospice.
MyoPro expected to be reimbursed by CMS in a lump-sum payment rather than as a rental should the proposal be finalized following a 60-day public comment period
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.
Alexander Schleider pleaded guilty before U.S. District Judge Michael A. Shipp in Trenton federal court to an information charging him with one count of conspiracy to commit health care fraud
NEWARK, New Jersey—An Ocean County, New Jersey, man admitted his role in a durable medical equipment (DME) kickback scheme, U.S. Attorney Philip R. Sellinger announced.
Alexander Schleider, 57, of Lakewood, New Jersey, pleaded guilty before U.S. District Judge Michael A. Shipp in Trenton federal court to an information charging him with one count of conspiracy to commit health care fraud and one count of wire fraud.
CMS has proposed an additional 5.653% permanent rate cut to begin in 2024 based on the same challenged payment methodology.
Washington, D.C.—The National Association for Home Care and Hospice (NAHC) filed a lawsuit against the Centers for Medicare and Medicaid Services (CMS) and the United States Department of Health and Human Services (HHS) challenging the validity of a change in Medicare home health payment that reduced rates by 3.925% in 2023 with significant additio
Tamara Yvonne Motley was found guilty by a federal jury of 20 counts of health care fraud
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.
CHAP answers agencies' questions regarding post-PHE waivers and flexibilities
The bill is designed to address deep cuts made to home health by CMS during the implementation of the Medicare home health payment system
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
TCT is a nationally recognized health care accreditation organization that provides comprehensive accreditation and certification services to healthcare providers in all 50 states
NEWTOWN, Pennsylvania—Helius Medical Technologies, Inc., a neurotech company focused on delivering a novel therapeutic neuromodulation approach for balance and gait deficits, announced its Portable Neuromodulation Stimulator (PoNS) device has been awarded durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) accreditation by The Compliance Team (TCT), which is authorized by the Centers for Medicare & Medicaid Services (CMS) to accredit all DMEPOS products and services.
AAHomecare and the ALS Association met with CMS Part C leadership to share concerns about authorization challenges for medically necessary NIV devices
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.
Average annual growth in national health spending over the next decade projected to be 5.4%
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.
Akintunde Oyewale was ordered to serve 4 years in federal prison
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.
Margait engaged in a scheme to defraud Medicare by illegally obtaining and selling fraudulent orders for DME paid for by Medicare.
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.
TRHC's comprehensive pharmacy services provide Mountain Empire PACE with individualized medication risk management, round-the-clock support, medication delivery and adherence packaging.
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.
Calling it a "landmark decision,"CMS announced it had, for the first time, made power seat elevation for power wheelchairs eligible for reimbursement as DME.
WASHINGTON—Calling it a "landmark decision," the Centers for Medicare & Medicaid Services (CMS) announced May 16, 2023 that it had, for the first time, made power seat elevation for power wheelchairs eligible for reimbursement as durable medical equipment (DME).
NAHC President talks quantifying the value of hospice
30.19 million of the 59.82 million people with both Medicare Part A and Part B were enrolled in a private plan
KFF reported that data released from the Centers for Medicare & Medicaid Services (CMS), shows Medicare Advantage (MA) now provides Medicare coverage for more than half of its eligible beneficiaries.
CMS posted 25 questions and answers and includes two specific to DME supplies and one for CGMs.
The Centers for Medicare & Medicaid Services (CMS) published the much-anticipated Frequently Asked Questions (FAQ) that provides some directions on the ending of the COVID-19 Public Health Emergency (PHE).
Prior to her new role, Verma was administrator of CMS.
AUSTIN, Texas—Oracle announced Seema Verma has been named senior vice president and general manager, Life Sciences. In this role, she will lead the Oracle Life Sciences and Oracle Cerner Enviza lines of business.
Witkowski fraudulently trafficked in orders for durable medical equipment (DME) such as back, knee and elbow braces.
NEW YORK—Damian Williams, the United States Attorney for the Southern District of New York, announced Matthew Taylor Witkowski was sentenced to 60 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 elbow braces. Witkowski previously pled guilty to the conspiracy charge and was sentenced before United States District Judge Denise L. Cote.
Nonmedical benefits have value for health & independence
WASHINGTON—The U.S. Department of Health and Human Services (HHS) announced it is releasing ownership data for all Medicare-certified hospice and homecare agencies. For the first time, anyone can now review detailed information on the ownership of more than 6,000 hospices and 11,000 home health agencies certified to participate in the Medicare program on the Centers for Medicare & Medicaid Services (CMS) website.