Search for: "Medicare, Medicaid & Medical Suppliers"
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7 Dec 2011, 8:05 am
On September 27, 2011, Hill-Rom Company, Inc., a durable medical equipment supplier, agreed to pay the United States $41.8 million to resolve allegations that it knowingly submitted numerous false claims to the Medicare program for medically unnecessary equipment and certain specialized medical equipment for patients who did not qualify for the equipment and for patients who had died or were no longer using the equipment. [read post]
21 Sep 2012, 7:25 am
Zone Program Integrity Contractors (ZPICs) are charged with detecting fraud, waste and abuse in Medicare Parts A, B, C, D, Durable Medical Equipment, Prosthetics, and Orthotics Suppliers (DMEPOS), Home Health and Hospice agencies (HH+H), and Medi-Medi (a partnership between Medicaid and Medicare designed to enhance collaboration between the two programs to reduce fraud, waste and abuse). [read post]
21 Sep 2012, 7:25 am
Zone Program Integrity Contractors (ZPICs) are charged with detecting fraud, waste and abuse in Medicare Parts A, B, C, D, Durable Medical Equipment, Prosthetics, and Orthotics Suppliers (DMEPOS), Home Health and Hospice agencies (HH+H), and Medi-Medi (a partnership between Medicaid and Medicare designed to enhance collaboration between the two programs to reduce fraud, waste and abuse). [read post]
21 Sep 2012, 7:25 am
Zone Program Integrity Contractors (ZPICs) are charged with detecting fraud, waste and abuse in Medicare Parts A, B, C, D, Durable Medical Equipment, Prosthetics, and Orthotics Suppliers (DMEPOS), Home Health and Hospice agencies (HH+H), and Medi-Medi (a partnership between Medicaid and Medicare designed to enhance collaboration between the two programs to reduce fraud, waste and abuse). [read post]
29 May 2023, 10:00 am
Medicare Advantage Plans are Aggressively Denying Claims – Administrative Appeals are Growing (May 25, 2023): According to the latest data released by the Centers for Medicare and Medicaid Services (CMS), beneficiaries participating in Medicare Advantage[1] plans now surpass those enrolled in original Medicare plans. [read post]
19 Dec 2022, 1:55 pm
Three consolidated False Claims Act ("FCA") lawsuits against chiropractor Yury Gampel ("Gampel"), 15 Modern Vascular office-based labs owned primarily by Gampel located across the United States, and five Modern Vascular-affiliated companies owned by Gampel alert other chiropractic, physician and other medical providers using office-based labs send a clear warning to other health care providers and suppliers for services covered or billed to Medicare,… [read post]
6 Jan 2014, 10:11 am
The Centers for Medicare and Medicaid services (CMS) has proposed rules for the Medicare Secondary Payer (MSP) appeals process that will target the “applicable plan” as the primary responsible party for recovery. [read post]
1 Nov 2016, 10:04 am
CMS has adopted a number of changes to its Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) policies for 2017, including new competitive bidding program (CBP) requirements and revisions to the methodology for updating Medicare DMEPOS fee schedule amounts based on CBP pricing. [read post]
25 Feb 2020, 3:00 pm
Expansion of the durable medical equipment (DME), prosthetics, orthotics, and supplies competitive bidding program to all geographic areas and to inhalation drugs, payment of contract suppliers based on their own bids, and elimination of the surety bid bond requirement [$7.73 billion Medicare savings, $435 million in Medicaid savings]. [read post]
23 Jul 2013, 11:59 am
The Centers for Medicare & Medicaid Services (CMS) is issuing demand letters seeking recoupment of reimbursement from medical providers and suppliers for Medicare beneficiaries that, according to data from the Social Security Administration (SSA), were allegedly "incarcerated" at the time services were provided. [read post]
15 Dec 2014, 7:56 am
Additional areas of focus include: quality and access in Medicare and Medicaid, public health and human services programs, and the appropriateness of Medicare and Medicaid payments. [read post]
8 Jan 2014, 8:44 am
CMS has issued regulations regarding emergency preparedness requirements for Medicare and Medicaid providers, Medicare Advantage/Part D policies, Medicare Secondary Payer rules, the ACA Basic Health Program, and 2014 Exchange enrollment deadlines. [read post]
21 Nov 2016, 2:46 pm
The Centers for Medicare & Medicaid Services (CMS) has issued its final Medicare physician fee schedule (MPFS) for calendar year (CY) 2017. [read post]
23 Sep 2007, 9:09 pm
Hospitals compensate for this by filing, often fraudulently, for reimbursement from Medicare and Medicaid for the supplies that they are purchasing. [read post]
14 Apr 2017, 12:08 pm
Also, CMS has gotten an early start on the calendar year (CY) 2018 rules, with the proposed updates for outpatient hospital departments/ambulatory surgical centers, home health agencies, end-stage renal disease providers, and suppliers of durable medical equipment, prosthetics, orthotics, and supplies all pending at OMB. [read post]
12 Apr 2018, 8:48 am
(April 12, 2018): The Centers for Medicare & Medicaid Services (CMS) utilizes a variety of private contractors to process Medicare claims and conduct both administrative and program integrity audits of claims submitted by healthcare providers and suppliers. [read post]
2 Oct 2010, 12:20 pm
What is surprising is the degree of consensus that Medicare’s shift to auctions is fatally flawed and must be fixed for the Medicare auctions to succeed in lowering costs while maintaining quality for medical equipment and supplies.For the last ten years, the Centers for Medicare and Medicaid Services has been testing an auction approach that is incredible in the inefficiency of its flawed design. [read post]
10 Dec 2013, 1:01 pm
CMS has issued several major Medicare payment rules for 2014, including rules updating reimbursement for hospital outpatient departments, ambulatory surgical centers, physicians and other Part B providers, end-stage renal disease facilities, durable medical equipment suppliers, and home health agencies. [read post]
20 Feb 2024, 5:00 am
Among the plethora of different contractors used by the Centers for Medicare & Medicaid Services (CMS) to administer the Medicare program is the Supplemental Medical Review Contractor, or SMRC. [read post]
15 May 2013, 2:24 pm
On May 13, 2013, the American Orthotic and Prosthetic Association ("AOPA") filed suit in the federal district court for the District of Columbia against the Centers for Medicare and Medicaid ("CMS"), alleging that payment denials by CMS and its Recovery Audit Contractors ("RAC") are invalid. [read post]
