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Waste and Fraud

July 19, 2017 | Daily News

House Ways & Means Republicans asked CMS acting program integrity director Jonathan Morse what additional tools the agency might need to help bring down improper payment rates in Medicare -- 11 percent for Medicare fee-for-service and about 10 percent for Medicare Advantage in fiscal 2016, according to the government's payment accuracy website -- but Morse did not ask for any additional authority, even though a representative from the Government Accountability Office suggested lawmakers could give CMS the authority to let Recovery Audit Contractors conduct pre-pay reviews.

June 30, 2017 | Daily News

Senate Finance ranking Democrat Ron Wyden said Friday (June 30) he is investigating whether CMS Administrator Seema Verma violated her ethics agreement by speaking to a Medicaid adviser to Arkansas’ Department of Human Services, a state covered by Verma’s ethics agreement due to her previous consulting work.

June 29, 2017 | Daily News

CMS restructures the Medicaid Eligibility Quality Control program into a pilot program that states conduct during years they do not participate in the Payment Error Rate Measurement program in a final rule released Thursday (June 29).

May 30, 2017 | Daily News

CMS is urging providers to start preparing for the new Medicare beneficiary cards without Social Security numbers that will come out next April followed by a 21-month transition period where providers can use either the current Social Security number-based claim number or the new Medicare Beneficiary Identifier.

May 23, 2017 | Daily News

President Donald Trump's plan to reform the Medicare appeals process includes policies similar to those put forward by the Obama administration last year, though Trump's plan leaves out a few of the Obama-proposed provisions.

May 05, 2017 | Daily News

CMS says it is considering structural improvements to the home health pre-claim review demonstration in response to stakeholder feedback, and the Center for Medicare Advocacy is gathering information on beneficiaries that have been required to wait for prior authorization or pre-claim review before receiving services.

April 19, 2017 | Daily News

Senate Judiciary Chair Charles Grassley (R-IA) is pushing CMS to step up its scrutiny of Medicare Advantage plans, asking the agency in a letter Monday (April 17) how often it audits MA plans and what steps it is taking to make sure insurance companies aren't fraudulently altering their risk scores to get more funding.

April 19, 2017 | Daily News

CMS says that putting in place new Unified Program Integrity Contractors will help the agency improve its communication with states about Medicaid program integrity, but the Government Accountability Office says it is too soon to tell how and whether the new contractors will address issues such as the burden collaborative audits impose on state staff and communication issues surrounding those audits.

February 13, 2017 | Daily News

A federal district court judge rejected an HHS call for dismissal of a lawsuit filed by Medicare beneficiaries calling for a right to appeal placement in observation status during hospital care.

February 08, 2017 | Daily News

An internal HHS memo, dated Feb. 6, says some positions at the Office of Medicare Hearings and Appeals and Departmental Appeals Board are exempted from President Donald Trump's federal hiring freeze.

February 08, 2017 | Daily News

An internal HHS memo dated Feb. 6 lays out jobs and occupations HHS has identified as exempt from President Donald Trump’s federal hiring freeze, however the specific impact on FDA and user fee hiring remains unclear.

February 08, 2017 | Daily News

Sen. Tom Carper (D-DE) is raising concerns that President Donald Trump's federal hiring freeze could leave Medicare and Medicaid more vulnerable to fraud if HHS can't hire staff focused on program integrity, though HHS Secretary-nominee Tom Price says if confirmed he will take into account the role of fraud fighters as he works with the White House to implement the freeze.

January 13, 2017 | Daily News

The Office of Medicare Hearings and Appeals issued a final rule Friday (Jan. 13) that lets agency attorneys handle some third-level appeals, allows for precedential decisions at the fourth level of appeals, and removes language that says Administrative Law Judges “must” issue a decision within 90 days, among other provisions that HHS officials say will streamline certain aspects of the appeals process.

January 05, 2017 | Daily News

A federal district court rejected HHS' request to reconsider its recent decision ordering the agency to eliminate a Medicare appeals backlog by 2021.