Tag: Medicaid
New York Medicaid increases access to standing frames
March 10, 2025HME News Staff
NEW YORK – HME stakeholders in New York have worked with the state’s Medicaid program to secure reimbursement increases for standing frame / table systems that support children with neuromuscular conditions that impair their ability to stand independently. Reimbursement for E0638 is now $3,264.65, up from $1,285.95; and reimbursement for E0641 is $3,526.92, up from $1,680.52. “New York’s children with profound medical needs now have access to the most medically appropriate...
Stakeholders try to ‘push through’
March 7, 2025Theresa Flaherty, Managing Editor
WASHINGTON – With Republicans looking to make steep cuts to government spending, it’s wait-and-see as to whether Medicare or Medicaid will be on the chopping block.
Industry stakeholders are optimistic, however, that these two large funding sources are safe – for now.
“There’s probably 10 moderate Republicans that will oppose any cuts in care – that’s kind of the third rail in politics,” says Jay Witter, senior vice president of public...
NCART update: Two more states approve power seat elevation
March 4, 2025HME News Staff
LUBBOCK, Texas – The Medicaid programs in North Dakota and Idaho have given the green light to power seat elevation, according to NCART. In North Dakota, the Medicaid program has approved the organization’s request to consider power seat elevation (E2298) as a covered benefit and has implemented coverage retroactively back to Feb. 1, 2025. The coverage criteria will be the same as those outlined in the National Coverage Determination and reimbursement will be set at $2,062.20. In Idaho,...
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...
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...
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...
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...
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...