Tag: Medicaid
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...
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...
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...
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...
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...
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...
Georgia: Providers ‘celebrate’ new contracts
June 12, 2024Theresa Flaherty
ATLANTA – Providers in Georgia, at press time, were waiting for the state Medicaid program to announce which case management organizations (CMOs) will receive contracts that include a new rate floor for DME.
In late 2023, Medicaid officials agreed to set the rate floor for DME at 100% of Medicaid fee-for-service rates and included the provision in its RFPs.
“(From providers in Georgia), I’ve heard of contracts that ranged from 60% to 80% of the current rate, so...
Aeroflow Health supports new moms in VA
May 20, 2024HME News Staff
ASHEVILLE, N.C. – Aeroflow Health is now serving the Virginia Medicaid population with lactation consultations. The company’s partnership with the state Medicaid program and its managed care organizations will connect new mothers to a network of lactation consultants and other maternal health services at little to no cost for them. “Aeroflow’s mission is to improve postpartum health outcomes for new mothers,” said Nicole Peluso, IBCLC, CD, CAHPE, Manager of Lactation...
KFF updates Medicaid enrollment tracker
April 29, 2024HME News Staff
WASHINGTON – At least 20.3 million Medicaid enrollees have been disenrolled as of April 18, 2024, based on the most current data from all 50 states and the District of Columbia, the Kaiser Family Foundation has reported. Overall, 31% of people with a completed renewal were disenrolled in reporting states, while 69%, or 44.4 million enrollees, had their coverage renewed (one reporting state does not include data on renewed enrollees), KFF reports. Other findings from the data, according to KFF:...
In brief: Cyberattack update, PBM reform, Medicaid hearing
April 26, 2024HME News Staff
MINNEAPOLIS – Change Healthcare says it has made “strong progress” restoring services impacted by a cyberattack in February.
In the April 22 update, Change Healthcare said that medical claims across the U.S. health system are moving at near-normal levels, as systems come back online or providers switch to other methods of submission. The company said it realizes there are a small number of providers who continue to be adversely impacted and it is working with them to find...