BOSTON, Massachusetts—The owner of Pharmagears, LLC (Pharmagears) and RR Medco, LLC (RR Medco) has agreed to plead guilty in connection with a nearly $30 million health care fraud conspiracy involving medically unnecessary durable medical equipment (DME), including orthotics such as back and knee braces.
SAN DIEGO, California—Chula Vista resident and businessowner Fernando Valenzuela Ayub pleaded guilty in federal court, admitting that he conspired with others to launder millions of dollars of health care fraud proceeds and paid unlawful kickbacks.
BALTIMORE, Maryland—The Centers for Medicare & Medicaid Services (CMS) announced a significant expansion of its auditing efforts for Medicare Advantage (MA) plans. Beginning immediately, CMS will audit all eligible MA contracts for each payment year in all newly initiated audits and invest additional resources to expedite the completion of audits for payment years 2018 through 2024.
NEW JERSEY—Congresswoman Mikie Sherrill (NJ-11) introduced the Protecting Retirement and Health Benefits for Working Families Act to safeguard Social Security, Medicaid, Medicare, Veterans Affairs and other critical federal benefits and services.
Sherrill said she introduced the bill in response to federal programs and jobs being cut by President Donald Trump and Elon Musk.
ANN ARBOR, Michigan—Long-term care services help meet health and personal care needs like bathing, dressing and eating when a person can no longer perform them independently. In August 2024, the University of Michigan National Poll on Healthy Aging asked a national sample of adults age 50 and older about their experiences with and views on planning and preferences for long-term care.
WASHINGTON—The Department of Health and Human Services (HHS) and the Office of Inspector General (OIG) released their fall 2024 semiannual report to congress (SAR), which found more than $7 billion in expected recoveries and receivables from misspent Medicare, Medicaid and other health and human services funds.
Editor’s Note: This story was written and released prior to any election result announcements.
By Stephanie Armour
On the campaign trail, both former President Donald Trump and Vice President Kamala Harris are eager to portray themselves as guardians of Medicare. Each presidential candidate has accused the other of backing spending cuts and other policies that would damage the health insurance program for older Americans.
WASHINGTON—Katie Smith Sloan, president and CEO of LeadingAge, an association of nonprofit providers of aging services, responded to a letter sent by 34 members of congress to President Joe Biden’s Administration regarding the Medicare Advantage (MA) plan “flex cards.
Below is Sloan's response:
BALTIMORE, Maryland—The Centers for Medicare and Medicaid Services (CMS) announced additional resources and flexibilities are available in response to Hurricane Milton in Florida. CMS is working with the state of Florida and federal partners to put these flexibilities in place in an effort to ensure those affected by this natural disaster have access to the care they need.
WASHINGTON—The Partnership for Quality Home Healthcare (PQHH), a coalition of Medicare home health providers aiming to increase access to quality homecare, released a third-party analysis of Medicare home health fee-for-service claims from 2022 through 2023, which found a decline in access to home health services for patients and families.
WASHINGTON—The House passed 14 new bipartisan health bills. The following bills were passed out of the House Energy and Commerce Committee and passed the House unanimously.
BALTIMORE, Maryland—The Centers for Medicare & Medicaid Services (CMS) announced additional resources and flexibilities are available in response to Hurricane Francine in Louisiana. CMS is working closely with the state of Louisiana to put these flexibilities in place to ensure those affected by the natural disaster have access to the care they need.
DALLAS—Intrepid USA Inc., headquartered in Dallas, and various wholly-owned subsidiaries have agreed to pay $3.85 million to resolve the allegations that Intrepid violated the false claims act in connection with two lines of its business. The first allegation was that Intrepid knowingly submitted claims to Medicare for home health care services for patients who did not qualify for the Medicare home health care benefit or where services otherwise did not qualify for Medicare reimbursement.
ATLANTA—The van Halem Group announced the addition of Melissa Pederson and Dr. William Felix to its team of expert consultants. Wayne van Halem, president of The van Halem Group, said he is thrilled to welcome them both to the team.
“Their background, skills and expertise are perfectly aligned with the services we provide to our clients, and we are lucky to have them,” said van Halem.
CONCORD, Florida—A Florida man pleaded guilty in federal court for his role in a conspiracy to defraud Medicare of $39.5 million, announced U.S. Attorney Jane E. Young.
Christopher Spellman of Port Richey, Florida, pleaded guilty to one count of conspiracy to commit health care fraud and was charged on July 17. U.S. District Court Judge Samantha Elliott scheduled sentencing for Nov. 21, 2024.
WASHINGTON—A new report from the 33rd annual Retirement Confidence Survey finds a decline in the confidence Americans feel in having enough money to live comfortably throughout their retirement years. The report also finds both workers and retirees are very concerned about inflation and its impact on their savings and spending.
