Tag: Medicare

FDA limits authorization for J&J COVID-19 vaccine

In a new message to providers May 5, 2022, CMS is noting that the FDA has limited the authorized use of the Janssen (Johnson & Johnson) COVID-19 vaccine. The vaccine is now only authorized for patients 18 years or older: For whom other authorized or approved COVID-19 vaccines are not accessible or clinically appropriate Who […]

DOJ alleges $10 million home health fraud scheme

A Texas home health agency owner is accused of fraudulently billing Medicare for more than $10 million, according to a release by the U.S. Department of Justice’s Southern District of Texas. Okorie Oko, 63, of Fresno, was arrested Thursday, April 28, 2022, and faces a five-count indictment, along with patient recruiter Henry C. Dobbins, 57, […]

CMS updates nine-state HHVBP model’s results

CMS has released the fifth annual report of the Home Health Value-Based Purchasing Model as officials prepare to roll the nine-state model out nationwide beginning in 2023. The findings from the new report note Total Performance Scores were 7% higher among agencies in the HHVBP states: Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee […]

Judge blocks CMS mandate in 10 states

A CMS mandate on COVID-19 vaccines has been put on hold in 10 states by a federal judge Monday, Nov. 29, 2021. The vaccine requirement for employees at certified Medicare and Medicaid providers was introduced in early November, with two deadlines: By Dec. 6, 2021, employees should have had their first shot or single shot […]

Provider pays $18.5M to resolve face to face, other Medicare claim allegations

Pennsylvania home health and hospice provider Geisinger Community Health Services (GCHS) will pay $18.5 million to resolve allegations of civil liability for submitting claims to Medicare for services that violated Medicare rules and regulations, according to the U.S. Attorney’s Office for the Middle District of Pennsylvania. After it discovered the problems, GCHS took corrective action […]

Beware of COVID-19 fraud scams

The OIG is alerting the public about fraud schemes related to COVID-19. Scammers are using telemarketing calls, text messages, social media platforms, and door-to-door visits offering COVID-19 tests, HHS grants, and Medicare prescription cards in exchange for personal details, including Medicare information. The OIG recommends the following in order to protect yourself from these scams: […]

SNFs explore home care options as Choose Home Care Act is introduced in the House

The Choose Home Care Act, legislation that aims to give Americans a choice on where to recover after a hospital discharge, was introduced into the House of Representatives on October 8. The bipartisan bill would create an add-on payment to traditional Medicare home health benefits for patients 30 days after hospital discharge. “Since being introduced […]

Fully risk-based payment models likely to decrease, CMS official says

Those working in healthcare should not expect many more fully risk-based payment models from the Center for Medicare and Medicaid Innovation (CMMI), CMS Chief Operating Officer Jon Blum said during the National Association of Accountable Care Organizations’ fall conference. “I don’t think that CMS will be promoting models that have more risk just for the […]

CMS survey seeks input on billing guidance and other resources

A new survey from CMS is looking to see what resources providers are using to understand the Medicare program and help them bill correctly. The survey is for providers or staff who provide services to people with Medicare and/or bill the Medicare program. The results are expected to help CMS improve your experience with resources […]

HHS prepares $25.5 billion in pandemic aid to providers

The Department of Health and Human Services (HHS) will make $25.5 billion available to health care providers impacted by the pandemic, with the application period opening Sept. 29. This funding includes $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP) or Medicare patients, and an […]