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Tag: Medicaid


News

Kennedy confirmed as health secretary

February 13, 2025HME News Staff

WASHINGTON – The U.S. Senate has confirmed Robert F. Kennedy Jr. as the next secretary of the U.S. Department of Health and Human Services in a largely party-line vote of 52-48.  Sen. Mitch McConnell, R-Ky., was the lone Republican to vote no.  Kennedy will replace Acting Secretary Dorothy Fink in overseeing the Food and Drug Administration, the Centers for Disease Control and Prevention and CMS.  While Kennedy made a name for himself during the election for his focus...

Health and Human Services, Medicaid, Medicare, National Community Pharmacists Association (NCPA), Robert F. Kennedy


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News

Missouri Medicaid to require firesafe cannulas

February 5, 2025HME News Staff

SPRINGFIELD, Mo. – Missouri’s Medicaid program, MO HealthNet, is now requiring DME oxygen providers to supply firesafe cannula valves to program participants, according to news reports.  The requirement, supported by representatives with the Springfield Fire Department, the Battlefield Fire District and the International Association of Fire Chiefs, went into effect Jan. 1 but will take time to implement across the state, according to the Springfield Daily Citizen.  “It’s...

Firesafe Cannula Valve, Home Oxygen Equipment, Medicaid, Missouri


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Providers

Lincare settles Medicaid investigation 

January 14, 2025HME News Staff

OLYMPIA, Wash. - The Washington state Attorney General’s Office has announced that Lincare has agreed to pay $1.15 million for allegedly overbilling Medicaid for rental oxygen equipment.  The state, based on an investigation by its Medicaid Fraud Control Division, alleges that Clearwater, Fla.-based Lincare, which has a billing office in Spokane Valley to manage its operations in the Pacific Northwest, knowingly billed rental fees beyond the three years allowed in more than 15 instances...

Lincare, Medicaid, overbilling, Settlement


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Also Noted

Diabetes, weight loss drugs cause spike in spending, utilization 

December 23, 2024HME News Staff

WASHINGTON – Medicaid spending on 10 selected diabetes and two selected weight loss drugs totaled more than $9 billion in 2023, a 540% increase compared to 2019, according to a new Data Brief from the Office of Inspector General.  “This substantial increase could have a financial impact on the Medicaid program,” the brief states. “Information in this data brief may be beneficial to CMS and State Medicaid agencies when developing future program guidance related to these...

Diabetes, Medicaid, utilization, weight loss drugs


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Julie Piriano

Mobility

Power seat elevation: NCART zeroes in on access issues in Medicaid

December 6, 2024Liz Beaulieu, Editor

WASHINGTON – Now that there is a Medicare code and payment for power seat elevation systems, NCART is doing the painstaking work of making sure state Medicaid programs have a pathway to also cover the technology.  In November, for example, the organization announced that it had secured coverage for E2298 for adults 21 and over in Alabama starting Jan. 1, 2025, with help from Cathy Carver, PT, DPT, ATP/SMS, at University of Alabama Birmingham/Spain Rehabilitation Center, as well the...

Home Medical Equipment (HME), Julie Piriano, Medicaid, NCART, Power seat elevation, Wheelchair


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El Paso woman sentenced in fraud case

December 4, 2024HME News Staff

EL PASO, Texas – An El Paso woman was sentenced to 60 months in prison for conspiracy to commit health care fraud. Edelmira Marquez, 59, engaged in fraudulent billing practices as the owner of Marquez Medical Supply, a durable medical equipment company located in El Paso. Marquez’s scheme involved substituting and providing lesser valued items to Medicaid and Medicare beneficiaries/patients, then billing Medicaid and Medicare for the greater valued items. The items were primarily continence...

health care fraud, Home Medical Equipment (HME), Medicaid


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Also Noted

Pharmacist sentenced for Medicare, Medicaid fraud 

October 25, 2024HME News Staff

LONDON, Ky. – Stephanie Collins, a former pharmacist, has been sentenced to 20 months for her role in a scheme to defraud Medicare and Medicaid by billing for medications that she never dispensed to her customers. According to her plea agreement, Collins operated as a registered pharmacist and operated Stephanie’s Down Home Pharmacy, a retail pharmacy located in Corbin, Ky.  The pharmacy sought reimbursement from Medicare and Kentucky Medicaid for drugs and other medical products...

Fraud, Medicaid, Medicare, retail pharmacy


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Also Noted

Woman charged with enteral fraud scheme 

August 19, 2024HME News Staff

DENVER – Colorado Attorney General Phil Weiser has filed fraud and theft charges against a woman in an alleged Medicaid fraud scheme that cost taxpayers more than $1.2 million in losses. Natasha Sawyer is accused of submitting false claims when she worked as a Medicaid biller for Element Medical Supply, a DME company. An investigation by the Medicaid Fraud Control Unit in the Colorado Department of Law found that from May 2020 to March 2021, Sawyer allegedly submitted false claims for enteral...

Fraud, Medicaid


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Florida Medicaid announces additional contracts

July 25, 2024HME News Staff

TALLAHASSEE, Fla. – Florida’s Agency for Healthcare Administration has announced additional statewide Medicaid managed care contracts for five companies following appeals of the original awards in April, AAHomecare reports.    The full scope of awards now includes:  Aetna Better Health of Florida* – Regions D, E, I  Florida Community Care* – Statewide  Humana Medical Plan – Statewide  Molina...

Florida, Managed Care, Medicaid


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State update: Carelon transition delayed 

July 1, 2024HME News Staff

WASHINGTON – Carelon Medical Benefits Management will not review Medicaid prior authorization requests for DMEPOS in Maryland (Wellpoint), Missouri (Healthy Blue) and Wisconsin (Anthem) on July 1 as planned, AAHomecare reports. The transition has been postponed until further notice, according to the association. “Suppliers in Maryland, Missouri and Wisconsin should continue to follow the current process when requesting authorizations for DMEPOS services under Medicaid,” AAHomecare...

Carelon, Medicaid, Prior Authorization


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