In brief: AO oversight finalized, Medicaid oversight tightened, scam campaign launched

WASHINGTON – The Centers for Medicare & Medicaid (CMS) has published a rule finalizing enhanced oversight of accrediting organizations (AOs).

The agency says the rule, “Strengthening Oversight of AO and Preventing AO Conflicts of Interest,” ensures that the organizations responsible for the oversight of more than 9,000 health care providers and suppliers use Medicare standards, and creates greater consistency between State Survey Agencies (SAs) and AOs in their survey processes.

“The work accrediting organizations do is vital, but it also raises an age-old question: Who watches the watchmen? The answer is, we do,” said CMS Administrator Dr. Mehmet Oz. “With this new rule, CMS is advancing its commitment to upholding rigorous standards for accrediting organizations and ensuring the health and safety of American patients.”

The rule is designed to:

• Ensure AO accreditation standards continue to meet or exceed those of the Medicare program.
• Align accreditation and survey processes with CMS requirements.
• Confirm AO enforcement of CMS requirements.
• Reinforce that all accredited entities must deliver safe, effective care.
• Prevent AO conflicts of interest that may arise from related consulting services.

Additionally, the rule creates a new process for monitoring AO performance; establishes consistent standards, processes, and definitions; updates validation and performance systems; requires AO surveyors to take the same CMS training as SA surveyors; and reduces burden on SAs, AOs, and providers by streamlining the CMS AO validation process.

CMS released a notice of proposed rulemaking (NPRM) on Feb. 8, 2024, revising its AO requirements to bolster oversight and ensure providers meet health and safety standards. The agency addressed the public comments received on the NPRM and is publishing the final rule with comment period.     

• To view the final rule on the Federal Register, visit: https://www.federalregister.gov/. 
• To view the Fact Sheet, visit: https://www.cms.gov/newsroom/fact-sheets/strengthening-cms-oversight-accrediting-organizations.

Rehab Medical, Cork Medical named in 'largest developer' list

INDIANAPOLIS – Rehab Medical and Cork Medical have been named to the Indianapolis Business Journal’s 2026 list of Largest Medical Device/Product Developers in the Greater Indianapolis area. Rehab Medical ranked No. 5, while Cork Medical ranked No. 17. “We are proud to see both Rehab Medical and Cork Medical recognized on this list as it reflects the consistent manner in which we have approached growth,” said Kevin Gearheart, Rehab Industries partner and president. “We have been intentional about building organizations that grow responsibly while staying anchored to our mission to improve lives.” The rankings, determined by the number of Indiana-area employees, reflect continued growth, innovation, and dedication to improving patient outcomes, the companies say. Rehab Medical, which recently marked its 20-year anniversary, attributed its placement in part to a new service model designed to shorten the process from referral to resolution when mobility equipment needs attention, helping users experience minimal downtime. The company also opened its first location in New York after acquiring Consolidated Medical and expanded services in Ohio after acquiring Boomers Medical Equipment (doing business as Risch Home Health). Cork Medical highlighted a $2 million investment in renovating its headquarters to improve collaboration, productivity, safety, accessibility and manufacturing workflows. The company also received the Indiana Chamber of Commerce’s Best Places to Work in Indiana award.

HHS launches elder justice, scam awareness campaign

WASHINGTON – The U.S. Department of Health and Human Services, through the Elder Justice Coordinating Council, has launched the Federal Elder Justice Action Plan, a government-wide strategy to protect older Americans’ rights, strengthen accountability and make help easier to find. HHS has also launched “Never EVER,” a national campaign designed to help people recognize and avoid government and business imposter scams. “Scammers steal an estimated $28 billion from older Americans each year,” said HHS Secretary Robert F. Kennedy, Jr. The EJCC, chaired by the HHS secretary, brings together 17 federal departments and agencies to strengthen collaboration, advance elder justice and protect older adults’ dignity, independence and financial security. Research estimates that roughly one in 10 older adults experiences abuse, neglect or exploitation every year, and Adult Protective Services programs receive about 1.3 million reports annually.

Louisiana strengthens Medicaid provider oversight

BATON ROUGE, La. – The Louisiana Department of Health is implementing enhanced provider oversight measures designed to strengthen Medicaid program integrity, protect beneficiaries and ensure taxpayer dollars are spent appropriately. The initiative includes more frequent reviews of high-risk providers, expanded provider verification requirements, enhanced monitoring and data analytics, and closer coordination with state and federal program integrity partners. “Every taxpayer dollar entrusted to Medicaid should be spent on delivering care to Louisianans who need it,” said LDH Secretary Bruce Greenstein. As part of the initiative, LDH will conduct off-cycle reviews of all designated high-risk providers that have not undergone a recent revalidation. Certain provider categories identified as presenting elevated program integrity risks will now be revalidated every three years instead of every five years. High-risk providers include durable medical equipment suppliers, home health agencies, hospice providers, personal care services providers and others identified through state and federal risk assessments. The department will also expand verification activities that help ensure participating providers are properly licensed, actively operating, and meeting enrollment requirements. Existing safeguards include site visits, ownership disclosure reviews, exclusion screenings and fingerprint-based criminal background checks for designated high-risk providers. LDH says it will work more closely with the Louisiana Office of Inspector General and other program integrity partners to analyze claims data, identify unusual billing patterns and detect potential concerns earlier. Additionally, the department is aligning with current federal provider enrollment moratoriums for certain high-risk provider categories, including durable medical equipment and home health providers.

Related reading:

• Ohio Gov. DeWine signs executive order aimed at Medicaid fraud.
• Florida Medicaid also issues moratorium on new DME suppliers.

WeInfuse, Eitan Medical partner on infusion workflow integration

DALLAS – WeInfuse has partnered with Eitan Medical to connect smart infusion pump technology with clinical workflows, helping infusion providers reduce manual documentation and spend more time on patient care, the companies say. WeInfuse provides software for infusion providers and specialty pharmacies, while Eitan Medical develops infusion therapy and drug delivery technologies, including its Sapphire and Avoset infusion pumps and Eitan Insights platform. The companies will integrate their software platforms to create connected infusion workflows and enable bidirectional data exchange for ambulatory infusion centers and home and specialty pharmacies. “By reducing manual handoffs between the pump and the supporting documentation, this integration will give clinicians more time for patient care,” said Roger Massengale, chief commercial officer at Eitan Medical. Eitan Medical’s infusion pumps will also integrate directly with WeInfuse’s InfuseTrack software, an asset and equipment management platform for infusion therapy operators. InfuseTrack will pull information from Eitan Medical’s fleet management system, allowing providers to track where pumps are located, and Eitan Medical’s preventive maintenance tracking system will automatically trigger maintenance checks in InfuseTrack.

VITAS Healthcare extends reach in Manatee County

BRADENTON, Fla. – VITAS Healthcare has expanded hospice care in Manatee County, Fla., making services available to hospice-eligible patients in Bradenton, Palmetto, Parrish, Lakewood Ranch and surrounding communities. The expansion comes as Manatee County’s population has grown by more than 15% over the past decade, reflecting demand for health care services that support older adults and people living with serious illnesses. “Families in Manatee County deserve timely, compassionate care at home,” said Anthony Cosma II, vice president of operations for VITAS. "We've seen a clear need for expanded hospice resources in this community, and we are honored to help meet that need. As Florida's leading hospice provider, we're proud to grow our presence here and ensure more patients receive the specialized care and support they deserve.” VITAS says referrals are available 24/7/365, with families able to request an eligibility evaluation online or by phone. Clinicians can also make secure referrals through the VITAS Healthcare mobile app. VITAS provides care primarily in private residences, assisted living communities and nursing homes, while also supporting patients who require a higher level of care through inpatient hospice settings and hospital partnerships. Its services include hospice care at home, respite care and home medical equipment.

AASM comments on CMS prior authorization rule

DARIEN, Ill. – The American Academy of Sleep Medicine (AASM) has submitted comments to the Centers for Medicare & Medicaid Services (CMS) supporting efforts to improve interoperability and digitize prior authorization through standardized electronic processes. CMS published the Interoperability Standards and Prior Authorization for Drugs Proposed Rule in April. AASM says electronic prior authorization and application programming interface-based data exchange have the potential to reduce care delays, improve workflow efficiency and enhance care coordination for patients requiring sleep testing, positive airway pressure therapy, medications and other sleep-related interventions. At the same time, AASM urged CMS to make sure the requirements are feasible for specialty practices, including small or resource-constrained sleep medicine practices. Key recommendations from AASM include:

• Expansion of electronic prior authorization for drugs across both medical and pharmacy benefits to reduce fragmented, manual processes
• Clear and consistent decision timeframes, including expedited pathways for clinically urgent therapies, such as treatments for narcolepsy and hypersomnia
• Greater transparency in denials, with specific explanations tied to clinical criteria and documentation requirements
• Public reporting of prior authorization metrics to improve accountability across payers
• Support for the exchange of clinically relevant sleep data, including polysomnography reports, home sleep apnea test results, PAP adherence data and validated questionnaires, through standardized APIs

AASM says successful implementation will depend on making interoperability and prior authorization reforms technologically robust, clinically practical and aligned with specialty care workflows.

Onera integrates home PSG solution with Somnoware

EINDHOVEN, Netherlands – Onera Health has integrated its Onera hPSG home polysomnography solution with Somnoware by Resmed, enabling clinicians to conduct polysomnography tests outside the traditional lab setting while managing their workflow using the sleep lab management software. “The integration with Somnoware is a welcomed enhancement that broadens access to the Onera hPSG solution,” said Ruben de Francisco, founder and CEO of Onera Health. “Many sleep centers are customers of both Onera and Somnoware. We are very pleased that the integration of our cloud-based platforms will enable clinicians to benefit from a streamlined clinical workflow while providing access to comprehensive sleep diagnostics, including web-based study review and reporting capabilities.” With the integration, study results are available in Somnoware for review, interpretation and management as soon as a study is complete, eliminating the need for manual file transfers or switching between platforms. Onera says the combination of home-based PSG testing and a more efficient workflow can increase access and convenience for patients, while providing comprehensive diagnostic insights to sleep medicine physicians.

Medela launches insurance platform for breast pumps

MCHENRY, Ill. – Medela has partnered with Covered Commerce to launch Medela Insurance Connect, a digital platform designed to make it easier for mothers in the United States to access insurance-covered breast pumps. Powered by Covered Commerce’s technology platform, Medela Insurance Connect helps users verify insurance eligibility, submit information and connect with partners to process their order and coordinate delivery of an insurance-covered Medela pump. “So many moms in the U.S. don’t even realize that you can access a pump for free, or very little out of pocket cost, by using their private insurance,” said Kelley Evans, executive vice president and head of commercial, Americas, Medela. “But navigating the insurance system can be complicated and overwhelming, especially with the growing list of to-dos prior to baby’s arrival.” Medela says the web-based platform is designed to help users start the insurance qualification process online in minutes, navigate eligibility with greater clarity, access its breast pumps through covered benefits and save time during pregnancy and postpartum. “Our mission is to make navigating health benefits simple for families,” said David Wagner, CEO at Covered Commerce. “Partnering with Medela is a natural fit to help families better understand and access their pregnancy benefits.”