Skip to Content

Tag: Medicare


Also Noted

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...

Fraud, Medicare


Read Full Articlered right arrow icon

Also Noted

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,...

Medicare, physicians, Reimbursement


Read Full Articlered right arrow icon

Also Noted

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...

Braces, Fraud, Medicare


Read Full Articlered right arrow icon

Also Noted

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)...

Falls, Medicare, Office of Inspector General (OIG), Reporting


Read Full Articlered right arrow icon

Also Noted

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...

Average Manufacturer Price (AMP), Average Sales Price (ASP), Medicare, Office of Inspector General (OIG), Price Substitution


Read Full Articlered right arrow icon

Also Noted

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...

Fraud, Medicare, Power mobility devices


Read Full Articlered right arrow icon

Also Noted

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...

Fraud, Medicare


Read Full Articlered right arrow icon

Mobility

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...

Medicare, Wheelchair


Read Full Articlered right arrow icon

News

MedPAC details Medicare spending and more 

August 1, 2023HME News Staff

WASHINGTON – The Medicare Payment Advisory Commission (MedPAC) has released its 2023 data book on health care spending and the Medicare program.  The 200-page report provides Medicare data on spending, demographics, beneficiary access to care, and quality of care, among other information.  Among MedPAC’s findings:  Medicare was the largest single purchaser of personal health care in the U.S., gobbling up 24% of total spend;  Medicare spending...

Medicare


Read Full Articlered right arrow icon

Also Noted

California fraud watch: Guilty verdict in Redondo beach

June 29, 2023HME News Staff

LOS ANGELES – Tamara Yvonne Motley, 54, a.k.a. “Tamara Ogembe,” of Redondo Beach, Calif., was found guilty of nearly two dozen felonies for billing Medicare more than $24 million by submitting fraudulent claims for medically unnecessary durable medical equipment – mostly power wheelchairs and repairs, many of which were never performed. She was found guilty by a federal jury of 20 counts of health care fraud, two counts of aggravated identity theft, and one count of conspiracy...

Fraud, Home Medical Equipment (HME), Medicare


Read Full Articlered right arrow icon