Durable Medical Equipment

News & Analysis as of

CMS Releases 2017 Medicare DMEPOS and Clinical Lab Fee Schedules

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

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

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

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

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

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

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

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

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

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

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

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

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

The Olympus Debacle: Why Internal Whistleblowing is a Good Thing for Compliance

The U.S. Department of Justice announced last week that Olympus Corporation of the Americas (OCA) agreed to pay $646 million to resolve three cases relating to its longstanding practice to bribe doctors and hospitals in the...more

Health Care E-Note - January 2016

The 2016 Medicare Physician Fee Schedule Final Rule ("Final Rule") contains recent changes to the Federal Stark Law, the majority of which took effect on January 1, 2016. The issuance of the Final Rule on November 16, 2015...more

CMS Finalizes Prior Authorization Program for Certain DMEPOS Items

On December 30, 2015, the Centers for Medicare & Medicaid Services (CMS) published its final rule establishing a prior authorization program for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS)...more

President Obama Signs Spending/Tax Deal with Medicare and ACA Provisions

On December 18, 2015, President Obama signed into law the Consolidated Appropriations Act of 2015, which includes a wide range of government spending and tax provisions. As previously reported, the Act includes the following...more

Bills Introduced to Modify Payments for DMEPOS

Two bills have been introduced in the House of Representatives and the Senate to modify payments for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). On November 19, 2015, Senator John Thune (R-SD)...more

HIPAA Lessons from the Warner Chilcott Settlement

Last week, the US Attorney’s Office in Boston announced that drug company Warner Chilcott agreed to plead guilty to health care fraud and pay $125 million to resolve criminal and civil liability arising out of allegations...more

Limited Modifications in Final ACO Fraud and Abuse Waivers Most Notably Include Cut of Gainsharing CMP Waiver

Nearly four years after publishing their joint interim final rule with comment period, effective November 2, 2011 (IFC), the OIG and CMS (Agencies) have finalized the waivers of various fraud and abuse laws in the context of...more

Also In The News - Health Headlines - October 2015 #4

Quality Improvement Organization Releases Guidance on Short-Stay Reviews – As previously reported, in July 2015, CMS announced that Quality Improvement Organizations (QIOs) would begin conducting reviews of certain inpatient ...more

CMS Not Implementing Changes to Miscellaneous DME Codes

CMS has announced that it will not adopt changes to miscellaneous durable medical equipment (DME) HCPCS codes on January 1, 2016, as it had proposed earlier this year in order to promote more accurate payment of DME claims....more

OIG Continues to Recommend Reduced Medicaid DME Reimbursement Rates

The HHS Office of Inspector General is once again calling for states to clamp down on Medicaid reimbursement for durable medical equipment (DME) and supplies. The OIG cites a series of earlier reports estimating that four...more

Prosecuting Doctors for Medicare Fraud

Federal prosecutors have turned their attention to physicians for Medicare fraud prosecution. Physicians who participate in the Medicare program have to be aware of the significant risks of Medicare fraud....more

President Obama Signs Steve Gleason Act and Independence at Home Act

On July 30, 2015, President Obama signed into law: ..S. 984, “Steve Gleason Act of 2015” – a bill to cover as durable medical equipment eye tracking and gaze interaction accessories for speech generating devices...more

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