In brief: OIG’s PAP investigation, Oz’s Medicaid revalidation initiative, CCS’s agentic AI platform
By HME News Staff
Updated 12:25 PM CDT, Mon April 27, 2026
WASHINGTON - Medicare payments made to suppliers for PAP devices generally complied with Medicare billing requirements, according to a new report from the Office of Inspector General (OIG).
For fiscal year 2017, the Comprehensive Error Rate Testing (CERT) Program determined continuous PAP (CPAP) devices had the second highest improper payment amount in the DMEPOS category, with estimated improper payments totaling $495 million for CPAP devices used for the treatment of obstructive sleep apnea (OSA).
The report found that:
- While Medicare payments to suppliers complied with Medicare billing requirements for 97 sampled PAP device claims, for the remaining 13 sampled PAP device claims, Medicare payments to suppliers did not comply with Medicare billing requirements. Specifically, Medicare made payments for PAP device claims that did not have the required documentation to support the services billed.
- In addition, some suppliers did not respond to OIG’s request for documentation to support the PAP device claims that were billed to Medicare.
The OIG recommended that CMS:
- Establish and implement internal controls to prevent improper payments for replacement PAP devices.
- Provide outreach and education to suppliers on document requirements.
CMS did not indicate concurrence or nonconcurrence with the first recommendation. The agency concurred with the second recommendation and described steps it has taken and plans to take to strengthen supplier education.
Oz announces new nationwide Medicaid anti-fraud effort but offers few details
WASHINGTON – Dr. Mehmet Oz announced last week that all 50 states will be required to explain their plans to revalidate some of their Medicaid providers.
Oz, Centers for Medicare & Medicaid (CMS) administrator, made the announcement April 21 during a health care summit hosted by Politico. In the announcement, he said CMS will ask states to share their strategies within 30 days, according to several online news reports.
"It's an example of what we'd like them to do to prove that they're serious about this," Oz said during the event. "And if you don't take it seriously, it indicates to us that we might have to take the audits that we're doing to the different states more aggressively," he said, without elaborating.
The announcement is the latest in a series of moves by the Trump administration aimed at what it believes is billions of dollars in fraud, waste and abuse. Most notably, in February, Oz imposed a six‑month nationwide moratorium on new Medicare enrollments of DMEPOS medical supply companies.
In March, the president signed an executive order creating the Task Force to Eliminate Fraud, which will advise the president and coordinate government-wide efforts to combat widespread fraud, waste and abuse in federal benefit programs.
CCS launches comprehensive AI platform
ST. PETERSBURG, Fla. – CCS has deployed a new agentic AI solution across its enterprise operations.
The solution, CeeCee, is a comprehensive platform trained on CCS’s own proprietary knowledge and data to deliver empathetic, personalized support that resonates with the chronic care population the company serves. It will serve complex patients at scale with measurable positive impact, including savings of more than 30% in annual operating costs.
“CeeCee and our broader agentic AI platform aren’t pilots or a proof of concept — they are enterprise-grade solutions operating across our entire organization right now, autonomously handling patient interactions, accelerating care delivery, and freeing our teams to focus on what they do best: providing compassionate, personalized support for complex chronic patient needs,” said Richard Mackey, chief technology officer at CCS.
The platform is projected to autonomously contain 25% of relevant incoming calls in the initial four months, while reducing call handling times across all interactions — resulting in improved patient experience while supporting the real-time needs of frontline teams.
CeeCee is expected to realize:
- 30%+ projected savings in annual operating costs.
- 25% of incoming patient calls autonomously contained within the first four months.
- Up to 20% reduction in customer service call handle times.
- 70–80% of 100,000+ monthly intake documents expected to be processed automatically by end of 2026 — getting patients on therapy weeks sooner.
CCS’s agentic AI deployment builds on the company’s proven track record of AI-driven results. In 2024, CCS launched PropheSee, a predictive analytics and intervention platform that generated more than $10 million in Medicare savings by proactively addressing CGM nonadherence in thousands of Medicare patients with diabetes.
For more information on CeeCee, CCS’s enterprise AI platform, please visit www.ccsmed.ai.
Health plans to standardize prior auth processes
WASHINGTON – Leading health plans will adopt a standardized approach for providers submitting electronic prior authorization requests for the majority of medical services, which they say will accelerate patient access to care and reduce administrative burdens for providers.
The standardized approach will be used for medical services that are commonly subject to prior authorization, such as orthopedic surgeries and imaging services, including CT scans and MRIs. These services span commercial coverage, Medicare Advantage and Medicaid managed care. Additional services will be added over time. The standards do not impact individual plans’ clinical policies or coverage determinations.
“As more providers adopt electronic prior authorization, this standardized approach will mean faster answers for patients, a more consistent experience for providers and less friction for everyone,” said Mike Tuffin, AHIP president and CEO.
This action reflects the continued progress in advancing the industry’s voluntary, multi-year commitments made in partnership with the Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS) in June 2025 to streamline and simplify prior authorization. The industry recently reported an 11% reduction in prior authorization volume as part of this initiative.
The industry is engaging with organizations representing providers and technology partners to share and receive feedback on the data requirements, with a goal of supporting the widest possible adoption beginning in 2027.
Participating health plans will continue adopting these standards on a rolling basis as the standardization commitment is implemented beginning Jan. 1, 2027. The initial list of health plans voluntarily participating in the standardization initiative includes:
- American Specialty Health
- AmeriHealth Caritas
- Arkansas Blue Cross and Blue Shield
- Blue Cross of Idaho
- Blue Cross Blue Shield of Alabama
- Blue Cross Blue Shield of Arizona
- Blue Cross and Blue Shield of Hawaii
- Blue Cross and Blue Shield of Kansas
- Blue Cross and Blue Shield of Kansas City
- Blue Cross and Blue Shield of Louisiana
- Blue Cross Blue Shield of Massachusetts
- Blue Cross Blue Shield of Michigan
- Blue Cross and Blue Shield of Minnesota
- Blue Cross and Blue Shield of Nebraska
- Blue Cross and Blue Shield of North Carolina
- Blue Cross Blue Shield of North Dakota
- Blue Cross & Blue Shield of Rhode Island
- Blue Cross Blue Shield of South Carolina
- BlueCross BlueShield of Tennessee
- Blue Cross Blue Shield of Wyoming
- Blue Shield of California
- Capital Blue Cross
- CareFirst BlueCross BlueShield
- CareSource
- Centene
- The Cigna Group
- CVS Health Aetna
- Elevance Health
- Evry Health
- Excellus Blue Cross Blue Shield
- Geisinger Health Plan
- GuideWell Mutual Holding Corporation (Florida Blue and Triple-S)
- Health Care Service Corporation
- Highmark Inc.
- Horizon Blue Cross Blue Shield of New Jersey
- Humana
- Independence Blue Cross
- Kaiser Permanente
- L.A. Care Health Plan
- Medical Mutual of Ohio
- Molina Healthcare
- Neighborhood Health Plan of Rhode Island
- Oscar Health
- Premera Blue Cross
- Regence BlueShield, Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah, Asuris Northwest Health, BridgeSpan Health
- SCAN Health Plan
- Sentara Health Plans
- UnitedHealthcare
- Wellmark Blue Cross and Blue Shield
Additional information on the industry’s voluntary commitments is available from AHIP and BCBSA.
Jim Binson passes away
CENTER LINE, Mich. – James “Jim” Binson passed away April 17 at the age of 82. He was the proud owner of Binson’s Medical Equipment and Supplies, a company deeply rooted in his family’s legacy. Founded in 1953 by his father, S. George Binson, Binson’s began as a small neighborhood pharmacy and grew into a nationally recognized, family-owned leader in home health care. Jim played a vital role in expanding that vision, helping transform the company into a trusted provider serving communities across multiple states, offering essential medical equipment, services, and care that allow people to live safely and comfortably in their own homes. He is survived by his wife, Pamela, children Bob, Jimmy, Brandi, Nick and Robbyn, several grandchildren and great-grandchildren and a large extended family.
Acelleron adds Spanish-language offerings to support resources
NORTH ANDOVER, Mass. – Acelleron has expanded its Education and Support Programs, a suite of accessible, unbiased offerings that fill critical gaps for families navigating pregnancy, breastfeeding and early parenting. To ensure greater equity and access, many of these resources are now offered in both English and Spanish, removing language barriers that too often prevent families from receiving timely, effective support, the company says. “Parents already have enough to navigate,” said Jason Canzano, managing director. “Our goal is to remove barriers, not add to them. These expanded education and support programs give families real, personalized guidance when they need it most, in a language that feels comfortable and familiar.”
Key program offerings include:
- Pump exploration webinar: A free, on-demand overview of breast pump types, parts, and usage, with guidance on choosing a pump based on individual lifestyles and needs.
- Pumping support consults: Personalized 1-on-1 virtual sessions such as Unbox Your Pump, Flange Fit Basics, and Return to Work 101 provide clear, practical guidance that empowers moms to feel confident and informed through varying stages of their pumping journey.
- Pumping support group: Led by an Acelleron IBCLC, this group allows moms to connect, share experiences, and discuss challenges at any stage of their lactation and pumping journey.
- YouTube videos and unboxing series: A growing video library provides equitable, easy-to-access education on breast pump overviews and use, flange fit, cycle speeds and settings, and more, helping families gain valuable knowledge.
In addition to family-facing resources, Acelleron continues to strengthen its Clinical Series, an ongoing educational series designed for providers working in lactation. Covering timely, clinician-requested topics, the series helps bridge the gap between providers and the pumping families they serve, supporting their ability to offer informed, compassionate care in a collaborative, dialogue-based environment.
Geriatric Medical, DDP Medical name Justin Racine chief digital officer
WOBURN, Mass. – GMSS Holdings, the parent company of Geriatric Medical & Surgical Supply and DDP Medical Supply, has named Justin Racine as chief digital officer. In this role, Racine will lead the organization’s digital transformation strategy, with a focus on advancing AI-driven commerce, enhancing customer experience, and aligning digital and physical operations across the enterprise. Racine brings more than 16 years of experience in brand strategy, digital commerce and marketing leadership. A published author and sought-after industry expert, he is known for translating complex business challenges into clear, compelling strategies that drive measurable impact – with a heavy focus on building experiences that humanize buying and product discovery. “Justin’s appointment marks an exciting milestone,” said Jeffrey Siegal, CEO Of GMSS Holdings. “His forward-thinking approach to digital innovation and deep expertise in AI-driven commerce make him uniquely positioned to build on our strong foundation – expanding our capabilities and accelerating the next phase of our growth.” Most recently, Racine served as AVP, Commerce Strategy, at Perficient, a global AI-first digital consultancy. “There’s real momentum across the platform right now, and I’m excited to help accelerate it,” said Racine. “This organization has always been rooted in service and strong customer relationships. Now, we will look to build on that foundation with modern digital capabilities—leveraging AI, unified commerce strategies, and innovative experience design—to better support our customers and partners.”
VGM, Trace Medical renew partnership expanding access to equipment
WHITMORE LAKE, Mich. – VGM and Trace Medical have partnered on an exclusive program agreement to expand VGM members’ access to Trace Medical’s advanced respiratory rentals, dialysis rentals and biomedical services nationwide. “We are very pleased with the continued growth of our relationship with VGM and its membership,” said Greg Apostolou, CEO of Trace Medical. “With ever-increasing industry margin pressure, our rental and biomedical service solutions are a natural fit for home medical equipment (HME) providers, and the VGM relationship allows seamless and efficient market access to provide meaningful value on a national scale.” The agreement, effective April 1, 2026, solidifies the first program of its kind for VGM’s membership community. It is designed to help HME providers address growing operational and margin pressures with scalable, reliable service solutions. "Trace Medical has been a trusted vendor partner of VGM since 2018, and we are excited to renew our relationship,” said Lindy Tentinger, president of VGM & Associates. “For our members, this partnership means dependable access to innovative solutions, from ventilator rentals to Trace’s newly established dialysis program, that help them operate more efficiently and better serve their patients.”
Senseonics launches Eversense 365 in Sweden, other countries to follow
GERMANTOWN, Md. – Senseonics Holdings has launched its Eversense 365 CGM system in Europe, following CE Mark approval in January. The Eversense 365 is now available to the first patients in Sweden, with launches to follow in Germany, Spain, and Italy during the coming weeks.The next-generation Eversense 365 doubles sensor lifespan from the previously available Eversense E3, from six months to a full year, and delivers key improvements such as reducing the frequency of calibrations from once daily to once weekly. “This launch of Eversense 365 is a significant breakthrough for diabetes technology in Europe and for Senseonics as a business, as we successfully transition to an end-to-end commercial organization this year,” said Tim Goodnow, PhD, president and CEO. “Building on demonstrable commercial momentum in the U.S., European expansion is a key part of our Eversense 365 growth strategy, increasing our total addressable market by over 30 million patients.” The Eversense 365, billed as the world’s first and only one-year CGM, was approved by the U.S. Food and Drug Administration (FDA) in September of 2024 and launched in the country one month later.
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