Tag: Medicare

WASHINGTON – Over half of the falls among Medicare home health patients hospitalized for falls with major injury were not reported on patient assessments by home health agencies (HHAs) as required, according to a new Office of Inspector General report. Due to this high rate of non-reporting, Care Compare may not provide accurate information about the incidence of these falls, the OIG says. Reporting on OASIS assessments was worse among younger home health patients (compared to older patients)...

WASHINGTON – Medicare and its enrollees have saved $73.4 million since 2013, because of CMS’s price substitution policy for Part B covered drugs, according to an August issue brief from the Office of Inspector General. They could have realized an additional $889,000 in savings in 2021, if CMS expanded the price-substitution criteria, the OIG says. When Congress established average sales prices (ASPs) as the basis for reimbursement for Medicare Part B drugs, it also provided a mechanism...

 BROWNSVILLE, Texas – Maria Luisa Yzaguirre and Jeremiah Yzaguirre, both of Harlingen, Texas, have been charged with conspiracy to commit health care fraud, aggravated identity theft and money laundering. The charges allege that between 2019 and 2023, the Yzaguires submitted more than $14 million in claims to Medicare for power wheelchairs, power scooters, parts and repairs for 37 individuals. In multiple instances, they allegedly billed Medicare more than $600,000 for parts and repairs...

 TRENTON, N.J. – Patrick Fitchner of Orlando, Fla., pleaded guilty Aug. 22 to one count of conspiracy to commit health care fraud in Trenton federal court. Fitchner and his conspirators solicited and received kickbacks and bribes in exchange for providing DME companies with completed doctors’ orders for medically unnecessary DME, such as orthotic braces, using telemedicine companies to obtain the prescriptions. The DME orders were subsequently fraudulently billed to Medicare and...

WASHINGTON – Medicare paid $30.1 million in repair costs for wheelchairs that exceeded the federally recommended limit during their reasonable useful lifetime, according to a new report from the Office of Inspector General.  Under Medicare, if the DME MACs determine that a beneficiary-owned wheelchair (after the 13-month rental period) will not last the full 5-year reasonable useful life (RUL), the supplier is responsible for replacing the wheelchair without charging the beneficiary...

WASHINGTON – The Medicare Payment Advisory Commission (MedPAC) has released its 2023 data book on health care spending and the Medicare program.  The 200-page report provides Medicare data on spending, demographics, beneficiary access to care, and quality of care, among other information.  Among MedPAC’s findings:  Medicare was the largest single purchaser of personal health care in the U.S., gobbling up 24% of total spend;  Medicare spending...

LOS ANGELES – Tamara Yvonne Motley, 54, a.k.a. “Tamara Ogembe,” of Redondo Beach, Calif., was found guilty of nearly two dozen felonies for billing Medicare more than $24 million by submitting fraudulent claims for medically unnecessary durable medical equipment – mostly power wheelchairs and repairs, many of which were never performed. She was found guilty by a federal jury of 20 counts of health care fraud, two counts of aggravated identity theft, and one count of conspiracy...

WASHINGTON – The Senior Medicare Patrol (SMP) projects reported $153,812 million in expected Medicare recoveries for 2022 but cautions that COVID-19 continues to limit its activities, according to a new report from the Office of Inspector General. In 2022, the 53 reporting SMP projects had a total of 5,365 active team members who conducted a total of 18,274 group outreach and education events, reaching an estimated 1 million people. In addition, the projects had 246,722 individual interactions...

YARMOUTH, Maine – Diabetes providers are striving to fill an information gap for referral sources who may not be familiar yet with changes to Medicare policy that expanded coverage for continuous glucose monitors (CGMs).  “Some (referral sources) are off to the races, but there’s a large number of members of the medical community that don’t know (about the changes),” said Matt Gallagher, CEO of Utah-based JQ Medical. “I think the industry is working through...

MIRAMAR, Fla. – A federal jury has convicted Steven King, 45, of Miramar, Fla., for conspiracy to commit health care fraud and wire fraud for dispensing unnecessary lidocaine and diabetes testing supplies and billing Medicare more than $50 million. King was the chief compliance officer of AIC Holdings, which held pharmacies in various states including All American Medical Pharmacy in Warren, Mich. King and his co-conspirators took several steps to conceal their scheme, including enrolling their...