Tag: Fraud
Program integrity: Timely filing change could be in play
October 16, 2026Liz Beaulieu, Editor
WASHINGTON – Home medical equipment (HME) providers are bracing for additional Medicare oversight measures as the Centers for Medicare & Medicaid Services (CMS) continues its efforts to combat fraud, waste and abuse, including a possible proposal that could impact timely filing requirements.
“We’re anticipating a new rule coming out that will touch us,” said Kim Brummett, senior vice president of regulatory affairs for AAHomecare. “We do think they’ve done a...
CMS, HHS tout enrollment enforcement of duplicate subsidies
October 15, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) in 2026 identified 189,000 people who had subsidized Obamacare coverage through the Federal Marketplace and who either had duplicate Medicare, Medicaid or Children’s Health Insurance Program (CHIP) coverage or were deceased. CMS says it took swift action to remove Obamacare subsidies for these people to save taxpayer dollars. “Taxpayers should not foot the bill for duplicate coverage or subsidies for people who have...
Fla. Medicaid integrity initiative shifts toward prevention
October 7, 2026HME News Staff
WEST PALM BEACH, Fla. – Florida Gov. Ron DeSantis said the state’s enhanced Medicaid program integrity efforts to combat fraud, waste and abuse are “delivering results.”
In June, DeSantis announced the most significant Medicaid integrity initiative in Florida history, shifting the state away from a “pay-and-chase” model toward preventing fraud before taxpayer dollars are spent.
The Agency for Health Care Administration (AHCA) strengthened provider screening...
In brief: MA fraud, Abbott settlement, MiniMed separation, SoClean commercial
September 16, 2026HME News Staff
WASHINGTON – The Office of Inspector General (OIG) says it has identified gaps in the screening process for fraudulent DMEPOS suppliers in Medicare Advantage.
The agency issued a report on Sept. 9 saying Medicare Advantage organizations (MAOs) conduct some screening checks on in-network suppliers but fewer checks of out-of-network suppliers. It also says:
The Centers for Medicare & Medicaid Services (CMS) does not screen all DEMPOS suppliers before they bill Medicare Advantage because...
OIG to CMS: ‘Medicare Advantage is also at risk’
September 14, 2026HME News Staff
WASHINGTON – The Office of Inspector General (OIG) says it has identified gaps in the screening process for fraudulent DMEPOS suppliers in Medicare Advantage.
The agency issued a report on Sept. 9 saying Medicare Advantage organizations (MAOs) conduct some screening checks on in-network suppliers but fewer checks of out-of-network suppliers. It also says:
The Centers for Medicare & Medicaid Services (CMS) does not screen all DEMPOS suppliers before they bill Medicare Advantage because...
CMS adds 11 medical supply companies to Preclusion List
September 9, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has identified and is barring 11 medical supply companies with more than $3.4 billion in suspected fraudulent billing practices in 2025 and 2026 from receiving future Medicare Advantage (MA) Part C and Part D payments.
According to the agency, these 11 durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers:
Had submitted no claims prior to 2025
Used improper billing practices for their claims
Had...
CMS Medicaid fraud effort stops $203M in payments
July 29, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) says its Medicaid Fraud War Room has stopped more than $203 million in potentially improper Medicaid payments during its first 88 days. Launched April 23, the initiative brings together CMS, the HHS Office of Inspector General, state Medicaid agencies and federal law enforcement partners to identify high-risk providers and coordinate enforcement actions. CMS says the effort uses advanced analytics to detect suspicious billing patterns...
CMS suspends more than 100 DME suppliers in fraud crackdown
July 23, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has suspended more than 100 DME suppliers and revoked the Medicare billing privileges of 725 suppliers as part of a broader effort to combat fraud in the program. CMS Administrator Mehmet Oz and Deputy Administrator Kimberly Brandt announced the enforcement actions during a July 9 press event, saying the suppliers had billed Medicare more than $1.5 billion. Brandt said the actions have “wiped out the majority of DME fraud...
Telemedicine company owner sentenced in Medicare fraud scheme
July 2, 2026HME News Staff
WASHINGTON – The owner of two telemedicine companies has been sentenced to 10 years in prison and ordered to pay $66 million in restitution for her role in a scheme to fraudulently bill Medicare for medically unnecessary durable medical equipment (DME) and prescription drugs, the U.S. Department of Justice announced. “The defendant – nurse practitioner responsible for the care and safety of her patients – exploited our health care system, conspiring to submit over $136 million...
In brief: AO oversight finalized, Medicaid oversight tightened, scam campaign launched
June 19, 2026HME News Staff
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...