Tag: Aetna
In brief: Fraud resource center returns, Aetna settles claims, REMSleep names new CEO
March 13, 2026HME News Staff
WATERLOO, Iowa – VGM Government Relations has refreshed and reintroduced its Fraud, Waste & Abuse (FWA) Reporting Resource Center to help protect the integrity of the DMEPOS industry and reinforce its commitment to ethical, compliant care.
The enhanced online hub includes:
Direct links to every state’s fraud reporting system
CMS federal reporting tools and guidance
Educational content to help suppliers identify, prevent and report suspected FWA
Compliance resources for...
Aetna agrees to $117.7M settlement to resolve False Claims Act allegations
March 12, 2026HME News Staff
WASHINGTON – Aetna has agreed to pay $117.7 million to resolve allegations that it violated the False Claims Act by submitting or failing to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage plan enrollees to increase its payments to Medicare, according to U.S. Department of Justice.
The government alleges that Aetna:
Submitted inaccurate and untruthful patient diagnosis data to CMS to inflate the risk adjustment payments it received from CMS;
Failed to...
Aetna clarifies use of G codes for CPAP claims
December 18, 2025HME News Staff
HARTFORD, Conn. – Aetna has clarified that, while durable medical equipment (DME) providers do not use G codes for traditional Medicare fee-for-service claims, it believes G codes can be used for commercial or Medicare Advantage claims, according to a bulletin from AAHomecare. The clarification is in response to industry concerns that the insurer was once again trying to require adherence codes G8851, G8854 and G8855 for reimbursement for CPAP devices or supplies,...
In brief: Aetna revisits CPAP code change, NHIA pushes bills, Insulet campaigns for diabetes
November 12, 2025HME News Staff
HARTFORD, Conn. - Aetna is once again trying to require adherence codes G8851, G8854 and G8855 for reimbursement for CPAP devices or supplies, the Midwest Association for Medical Equipment Services & Suppliers (MAMES) reports.
The insurer tried the same move earlier this year, but after the HME industry pushed back, saying providers can’t bill these codes, it pulled back the change.
In an October 2025 list of upcoming policy changes and reminders, however, Aetna states:
“Beginning...
Aetna tries to change coding requirements for CPAP devices – again
November 11, 2025HME News Staff
HARTFORD, Conn. - Aetna is once again trying to require adherence codes G8851, G8854 and G8855 for reimbursement for CPAP devices or supplies, the Midwest Association for Medical Equipment Services & Suppliers (MAMES) reports.
The insurer tried the same move earlier this year, but after the HME industry pushed back, saying providers can’t bill these codes, it pulled back the change.
In an October 2025 list of upcoming policy changes and reminders, however, Aetna states:
“Beginning...
In brief: Aetna pauses CPAP change, FDA warns Dexcom, Owens & Minor launches offering
March 28, 2025HME News Staff
WASHINGTON – Aetna has put a proposed change on hold for review after AAHomecare asked the insurer to reconsider using certain adherence codes that can only be billed by clinicians not DME providers.
The proposed change, announced in January, stated: “Beginning April 1, 2025, we’ll no longer reimburse the CPAP device or the supplies unless adherence to positive airway pressure therapy is documented using adherence codes G8851, G8854 and G8855 on the claim.”
“On...
Aetna pauses CPAP change
March 27, 2025HME News Staff
WASHINGTON – Aetna has put a proposed change on hold for review after AAHomecare asked the insurer to reconsider using certain adherence codes that can only be billed by clinicians not DME providers.
The proposed change, announced in January, stated: “Beginning April 1, 2025, we’ll no longer reimburse the CPAP device or the supplies unless adherence to positive airway pressure therapy is documented using adherence codes G8851, G8854 and G8855 on the claim.”
“On...
Judge presses pause on CVS-Aetna deal
December 5, 2018HME News Staff
WOONSOCKET, R.I. - A federal judge has told CVS Health Corp. and Aetna not to begin their integration until he has a chance to weigh in on their $70 billion merger. CVS announced on Nov. 28 that the transaction was completed. U.S. District Judge Richard Leon said, however, that the two companies have until Dec. 14 to show him why they should be allowed to continue with the integration, according to an article on modernhealthcare.com. It is unclear whether Leon has any power to forestall the integration,...
CVS-Aetna deal clears major hurdle
October 11, 2018HME News Staff
WOONSOCKET, R.I. - The U.S. Department of Justice on Wednesday approved the $69 billion merger between CVS Health and Aetna.
The deal, which is expected to be finalized in the fourth quarter of 2018, is still subject to state regulatory approvals, many of which have been granted, according to a press release.
"DOJ clearance is an important step toward bringing together the strengths and capabilities of our two companies to improve the consumer health care experience," said CVS Health President...
Diabetes, sleep and one really big deal
January 23, 2018Theresa Flaherty, Managing Editor
It was one of the last stories we published in 2017, but a potential merger of giants topped the list of most read specialty stories for the year.
The No. 1 story, “CVS-Aetna deal casts chilling shadow over pharmacy landscape,” about CVS's plan to pay approximately $69 billion for the health insurer, deals with the potential negative impact on privately-owned pharmacies. It's easy to see how this latest news of consolidation within the healthcare industry would strike a note...