Tag: Medicare
CMS proposes policies to support underserved communities
April 11, 2024HME News Staff
WASHINGTON – CMS has issued a proposed rule to improve the health of Medicare beneficiaries by addressing social determinants of health, strengthening emergency preparedness, and improving maternal health.
The fiscal year (FY) 2025 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) rule builds on the Biden-Harris Administration’s work to support historically underserved and under-resourced communities and promote...
Uncertainty surrounds reimbursement relief
March 19, 2024HME News Staff
WASHINGTON – Industry stakeholders are on the hunt for another vehicle for their legislation to extend the 75/25 blended Medicare reimbursement rate in non-rural areas through 2024.
AAHomecare reports that its lobbyists and HME advocates on the Hill have indicated that reimbursement relief will not be included in a second segment of appropriations language that must pass Congress by March 22 to prevent another government shutdown.
“We will continue to look for other...
Georgia man pleads guilty to $127M fraud scheme
December 21, 2023HME News Staff
NEWARK, N.J. – Nicco Romanowski, of Roswell, Ga., pleaded guilty to conspiracy to violate the federal anti-kickback statute and conspiracy to commit health care fraud. From June 2017 through May 2019, Romanowski participated in a scheme with DME companies, telemedicine companies and doctors to submit false claims to health care benefit programs, including Medicare and Tricare. In total, Romanowski and his conspirators caused the submission of false and fraudulent claims to health care benefit...
Reps seek to eliminate physician cut
December 11, 2023HME News Staff
WASHINGTON – A group in the House of Representatives led by Rep. Greg Murphy, R-N.C., Danny Davis, D-Ill., Brad Wenstrup, R-Ohio, Jimmy Panetta, D-Calif., Larry Bucshon, R-Ind., and Michael Burgess, R-Texas, has introduced a bill that would eliminate the 3.37% cuts to Medicare payments for physicians scheduled to go into effect Jan 1, 2024. “As of today, patients and physicians have a clear-eyed view on how to protect Medicare from injurious cuts,” said Jesse Ehrenfeld, M.D., M.P.H,...
Two plead guilty in brace scheme
November 14, 2023HME News Staff
ATLANTA – Brett Weiner and Valerie Desalvo have pleaded guilty to federal conspiracy charges for their role in buying and selling fake doctors’ orders used to obtain more than $1.5 million in fraudulent payments from Medicare, according to the U.S. Attorney’s Office for the Northern District of Georgia. Weiner and Desalvo owned and operated Laboratory Marketing Services, a business in Boca Raton, Fla., that, among other things, received kickback payments in exchange for patient...
OIG questions HHA fall reporting
September 11, 2023HME News Staff
WASHINGTON – Over half of the falls among Medicare home health patients hospitalized for falls with major injury were not reported on patient assessments by home health agencies (HHAs) as required, according to a new Office of Inspector General report. Due to this high rate of non-reporting, Care Compare may not provide accurate information about the incidence of these falls, the OIG says. Reporting on OASIS assessments was worse among younger home health patients (compared to older patients)...
Price substitution policy works, OIG says
September 5, 2023HME News Staff
WASHINGTON – Medicare and its enrollees have saved $73.4 million since 2013, because of CMS’s price substitution policy for Part B covered drugs, according to an August issue brief from the Office of Inspector General. They could have realized an additional $889,000 in savings in 2021, if CMS expanded the price-substitution criteria, the OIG says. When Congress established average sales prices (ASPs) as the basis for reimbursement for Medicare Part B drugs, it also provided a mechanism...
Two charged in Medicare scam for power mobility
August 31, 2023HME News Staff
BROWNSVILLE, Texas – Maria Luisa Yzaguirre and Jeremiah Yzaguirre, both of Harlingen, Texas, have been charged with conspiracy to commit health care fraud, aggravated identity theft and money laundering. The charges allege that between 2019 and 2023, the Yzaguires submitted more than $14 million in claims to Medicare for power wheelchairs, power scooters, parts and repairs for 37 individuals. In multiple instances, they allegedly billed Medicare more than $600,000 for parts and repairs...
Florida man pleads guilty to fraud
August 24, 2023HME News Staff
TRENTON, N.J. – Patrick Fitchner of Orlando, Fla., pleaded guilty Aug. 22 to one count of conspiracy to commit health care fraud in Trenton federal court. Fitchner and his conspirators solicited and received kickbacks and bribes in exchange for providing DME companies with completed doctors’ orders for medically unnecessary DME, such as orthotic braces, using telemedicine companies to obtain the prescriptions. The DME orders were subsequently fraudulently billed to Medicare and...
OIG: Medicare overpaid for wheelchair repairs
August 10, 2023HME News Staff
WASHINGTON – Medicare paid $30.1 million in repair costs for wheelchairs that exceeded the federally recommended limit during their reasonable useful lifetime, according to a new report from the Office of Inspector General.
Under Medicare, if the DME MACs determine that a beneficiary-owned wheelchair (after the 13-month rental period) will not last the full 5-year reasonable useful life (RUL), the supplier is responsible for replacing the wheelchair without charging the beneficiary...