News & Analysis as of

Durable Medical Equipment

CMS Retroactively Revises DMEPOS Fee Schedule to Implement Cures Act

by Reed Smith on

CMS has announced revised Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule amounts for the period of July through December 2016, as required by the 21st Century Cures Act. By way...more

Georgia Law Requires Durable Medical Equipment Suppliers to be Licensed

by Arnall Golden Gregory LLP on

On March 30, 2017, the Georgia State Senate voted to pass SB41, which amends the Georgia Pharmacy Practice Act, regulating the practice of pharmacy in the state of Georgia. After passing both the House and Senate, the bill is...more

Cuts to Medicare DMEPOS Payment Based on Competitive Bidding Prices – Opportunity to Comment

by Reed Smith on

CMS is seeking input from stakeholders on how it should use data from the durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding program to adjust (cut) Medicare DMEPOS fee schedule...more

Health Care Fraud and Abuse in the Middle District of Florida in 2016 - a Year in Review

by Carlton Fields on

The United States Attorney’s Office (USAO) for the Middle District of Florida (USAO-MDFL) prosecuted several civil health care fraud matters in 2016 and issued related press releases. A review of the USAO-MDFL’s criminal and...more

CMS Provides Sneak Preview of Future DMEPOS Competitive Bidding Plans Before Retracting Announcement

by Reed Smith on

One week after unveiling the next round of Medicare durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding, the Centers for Medicare & Medicaid Services (CMS) has announced a “temporary...more

Will Florida's Crazy PIP Litigation Soon Be a Thing of the Past?

Following an automobile accident, injured parties need immediate funds to pay for medical expenses. To ensure that injured persons have the ability to obtain necessary healthcare, Florida law requires auto insurers to...more

Qualifications for Artificial Limb Suppliers, After Only 16 Years

by Faegre Baker Daniels on

Bill Clinton was President when Congress enacted a law requiring CMS to come up with qualifications for those who make or supply artificial limbs to Medicare patients. It was January 11, 2017, when CMS finally unveiled the...more

“Should Auld Acquaintance Be Forgot” - Performant to Initiate Home Health, Hospice, and DME Audits in 2017

The final quarter of 2016 ended with the Centers for Medicare & Medicaid Services (CMS) announcing Performant Recovery, Inc. (Performant) as the new national Recovery Audit Contractor (RAC) to focus solely on Home Health,...more

GAO Assesses Impact of Medicare DMEPOS Competitive Bidding Program on Beneficiary Access, OIG Documents Market Share for Diabetes...

by Reed Smith on

The number of Medicare beneficiaries who received durable medical equipment (DME) items generally fell after Round 2 of competitive bidding program (CBP) and the national mail-order program for diabetes testing supplies were...more

CMS Announces New Medicare Prior Authorization Requirements for Two Types of Power Wheelchairs

by Reed Smith on

Beginning in March 2017, CMS is phasing in new Medicare prior authorization (PA) requirements for two types of power wheelchairs under a policy adopted in a final rule issued late in 2015. As previously reported, CMS...more

Medicare, Medicaid Payment Policies, Fraud Authorities Enacted as Part of 21st Century Cures Act

by Reed Smith on

On December 13, 2016, President Obama signed into law the 21st Century Cures Act (Cures Act). While much of the focus has been on policies intended to accelerate drug and device development and approval, the Cures Act also...more

Implications of the Medicare and Medicaid Provisions in the 21st Century Cures Act

by K&L Gates LLP on

On December 7, 2016, Congress passed the 21st Century Cures Act (the “Act”). The Act began as a proposal to increase funding to the National Institutes of Health (“NIH”) and streamline the Food and Drug Administration’s...more

CMS Releases 2017 Medicare DMEPOS and Clinical Lab Fee Schedules

by Reed Smith on

CMS has announced 2017 Medicare fee schedule rates for durable medical equipment (DME) prosthetic orthotics and supplies (DMEPOS) furnished in non-competitive bidding areas. The calendar year 2017 DMEPOS update factor is 0.7...more

CMS Issues CY 2017 ESRD Final Rule

by Baker Ober Health Law on

On October 28, 2016, CMS issued the final rule updating the payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services beginning in CY 2017. The rule also...more

Recent Settlements Demonstrate the Reach and Versatility of the FCA

by Bass, Berry & Sims PLC on

In recent years, civil enforcement efforts involving the FCA have grown significantly. Today, the FCA impacts a vast array of businesses, as it is commonly used to redress false claims for government funds involving...more

CMS's Payment Suspensions Wreak Havoc: Understanding the Risks

by Baker Ober Health Law on

CMS payment suspensions can cripple any provider's or supplier's operations. Yet, CMS has the authority to impose a payment suspension upon the mere existence of "reliable information" that an overpayment or fraud may exist....more

OIG Urges CMS to Change Medicare Infusion Drug Payments

by King & Spalding on

The Office of Inspector General (OIG) issued a report on September 7, 2016 urging CMS to overhaul the way it pays for drugs infused through durable medical equipment (DME) provided to Medicare Part B beneficiaries. Current...more

CMS Posts Corrections to July 2016 DMEPOS Fee Schedule Rates

by Reed Smith on

CMS has identified errors in its July 2016 update to Medicare durable medical equipment (DME) prosthetic orthotics and supplies (DMEPOS) fee schedule amounts for certain items in non-competitive bidding areas. According to an...more

Don’t Discount the Government’s Recent Statement of Interest in False Claims Act Case

by Alston & Bird on

On August 8, 2016, the U.S. government filed a Statement of Interest in an ongoing False Claims Act (FCA)/Anti-Kickback Statute (AKS) case, U.S. ex rel. Herman v. Coloplast Corp., No. 1:11-cv-12131 (D....more

CMS Proposes CY 2017 Home Health PPS Rate, Updates to ValueBased Purchasing Model and Quality Reporting

by McDermott Will & Emery on

The US Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) released proposed updates to its Calendar Year (CY) 2017 Home Health Prospective Payment System (HH PPS) in the July 5, 2016,...more

DME MACs Warn Suppliers Not to Rely on Manufacturer Coding Advice

by Reed Smith on

The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have issued a Correct Coding article on “HCPCS Coding Recommendations from Non-Medicare Sources,” which discusses Medicare supplier responsibility...more

Biblical Name No Shield Against Fraud Charge

by Faegre Baker Daniels on

On May 2 a New Orleans federal jury found that Psalms 23 DME, LLC—its Biblical name notwithstanding–was part of a fraud scheme that illegally billed Medicare $3.2 million. In 2013 the government indicted Psalms 23 owner...more

CMS Issues Proposed Rule to Establish a Medicare Part B Drug Pricing Demonstration

by Arnall Golden Gregory LLP on

On March 11, 2016, the Centers for Medicare & Medicaid Services (CMS) published in the Federal Register a proposed rule that establishes a demonstration to test alternative drug payment approaches under the Medicare Part B...more

CMS Proposes Part B Drug Payment Model

by King & Spalding on

On March 8, 2016, CMS released a proposed rule on implementation of a new two-phase Medicare Part B Drug Payment Model (the “Model”) that would test whether alternative payment approaches would lead to a reduction in Medicare...more

Opt-out class actions in the UK – off the blocks, on a mobility scooter

by White & Case LLP on

A new opt-out class action regime was introduced into the UK on 1 October 2015 under the Consumer Rights Act 2015 (the "CRA"). Since then, practitioners have been waiting patiently; intrigued to see when the first claim would...more

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