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Waste and Fraud

November 01, 2018 | Daily News

The federal DC district court again ordered HHS to clear the backlog of Medicare appeals, saying that since the department told the court it could clear the backlog in fiscal 2022, the agency should do so by the end of that year and provide the court with updates on its progress.

October 25, 2018 | Daily News

Two California men have pleaded guilty to conspiring to defraud Affordable Care Act plans in at least 12 states by enrolling people in coverage and transporting them to expensive drug treatment facilities in California that paid referral and other fees, the Department of Justice announced.

September 10, 2018 | Daily News

A federal judge on Friday (Sept. 7) struck down a 2014 CMS rule that imposed a strict definition of Medicare Advantage overpayments and an exacting liability standard for when MA plans were required to report such overpayments and return them to CMS.

August 28, 2018 | Daily News

CMS is negotiating with inpatient rehabilitation facilities to potentially settle Medicare appeals, HHS says in a recent court briefing, and additional settlement meetings with the IRF lobby are expected in the upcoming months.

August 28, 2018 | Daily News

HHS projects that recent settlements and increased funding from Congress should allow the department to eliminate the Medicare appeals backlog in fiscal 2022 -- assuming the higher funding level for the Office of Medicare Hearings and Appeals continues -- so the district court shouldn't require anything but status reports from the department.

August 24, 2018 | Daily News

The HHS Office of Inspector General is asking for feedback on how to coordinate the anti-kickback and physician self-referral, or Stark, laws as well as how to set up safe harbors to help alternative pay models and the possibility of letting providers waive co-pays or provide other incentives to beneficiaries as a way to promote care engagement.

August 22, 2018 | Daily News

CMS will tweak a demonstration in order to continue allowing providers affected by state-wide moratoria on home health agencies and non-emergency ambulances to participate in Medicare, Medicaid and CHIP if there are proven access to care concerns, and the agency also will allow those that had a pending application denied when state-wide moratoria kicked in to participate in the programs through the demo.

August 14, 2018 | Daily News

Home health providers question how CMS' revamped home health demonstration will help stem fraud when the agency has recognized the high improper pay rate in that sector appears to be driven largely by paperwork problems, and suggest CMS look at alternatives.

July 30, 2018 | Daily News

CMS on Monday (July 30) announced it would continue for another six months moratoria on Medicare, Medicaid and CHIP participation for new non-emergency ground ambulance suppliers in New Jersey and Pennsylvania and home health agencies in Florida, Illinois, Michigan and Texas.

July 27, 2018 | Daily News

CMS should do more to oversee program integrity in Medicaid managed care, the Government Accountability Office said in a report released Thursday (July 26), the third report in two months by a government watchdog agency calling for greater supervision of Medicaid managed care.

July 27, 2018 | Daily News

CMS Administrator Seema Verma said the agency has a long way to go to prevent Medicare waste, fraud and abuse, and pointed to the small percentage of claims that Medicare reviews, though Center for Program Integrity Director Alec Alexander recently touted Medicare's falling improper pay rate before a House Ways & Means panel.

July 03, 2018 | Daily News

Hospitals will have greater latitude to use administrative appeals to challenge how much money they receive from Medicare under a ruling issued Friday (June 29) by the U.S. Court of Appeals for the DC Circuit.

June 06, 2018 | Daily News

The Government Accountability Office says in a Wednesday (June 6) report that CMS isn't looking closely enough at Medicaid managed care plans, including whether those plans overpay providers or have so-called unallowable costs, and the office recommended that CMS take steps to make sure it is accurately looking at Medicaid plans' improper pay rate.

April 13, 2018 | Daily News

House lawmakers raised concerned the Medicaid data collected by CMS isn't good enough for use in improving improper payment rates, and House oversight government operations subcommittee Chair Mark Meadows (R-NC) asked CMS Medicaid chief Tim Hill to give lawmakers a plan for how the agency will improve the data.

February 23, 2018 | Daily News

Republican House Energy & Commerce leaders are asking HHS Secretary Alex Azar how he plans to fix the Medicare appeals backlog, the Medicaid improper pay rate and Medicaid financial reporting problems.

November 30, 2017 | Daily News

While senators are continuing to push CMS to take action to deal with elder abuse and other nursing home concerns, including inquiries from Sen. Elizabeth Warren (D-MA) to HHS Secretary-nominee Alex Azar, the subject was not broached at Wednesday's (Nov. 29) hearing by the Senate health committee.

November 27, 2017 | Daily News

The drop in CMS' improper pay rate for fee-for-service Medicare was driven by a reduction in improper pay to home health agencies and inpatient rehabilitation facilities -- though CMS says home health companies and IRFs, along with nursing homes, were the major contributors to the 9.5 percent improper pay rate in fiscal 2017, and the HHS Office of Inspector General said program integrity is still a top management challenge for the agency.

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).

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