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Man Charged for Over $70M Medicare Fraud Scheme

An indictment was unsealed in Tampa last week charging a Mississippi man for his alleged role in an over $70 million fraud scheme involving the payment of kickbacks and bribes to obtain doctors’ orders for medically unnecessary durable medical equipment (DME).

April 24, 2024

CMS Statement on Agent and Broker Marketplace Activity

CMS is committed to protecting consumers in the Marketplace.

April 24, 2024

Final Defendants Sentenced in $65 Million TRICARE Fraud

The final two members of a massive conspiracy to bilk TRICARE, the military’s healthcare program, out of more than $65 million have been sentenced in federal court.

April 23, 2024

FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Proposed Rule – CMS-1808-P Fact Sheet

The Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2025 Medicare hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) proposed rule.

CMS Proposes New Policies to Support Underserved Communities, Ease Drug Shortages, and Promote Patient Safety

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule updating Medicare payments and policies for inpatient hospitals and long-term care hospitals.

Proposed FTC Order will Prohibit Telehealth Firm Cerebral from Using or Disclosing Sensitive Data for Advertising Purposes, and Require it to Pay $7 Million

Cerebral, Inc. has agreed to an order that will restrict how the company can use or disclose sensitive consumer data and require it to provide consumers with a simple way to cancel services to settle Federal Trade Commission charges that the telehealth firm failed to secure and protect sensitive health data.

SAMHSA and ONC Launch the Behavioral Health Information Technology Initiative

The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of the National Coordinator for Health Information Technology (ONC) will work together to invest more than $20 million of SAMHSA funds over the next three years in an initiative to advance health information technology (IT) in behavioral health care and practice settings.

United States Files Complaint Against Regeneron Pharmaceuticals Alleging Fraudulent Drug Price Reporting

The United States has filed a complaint under the False Claims Act (FCA) against Regeneron Pharmaceuticals, Inc. (Regeneron), a New York-based pharmaceutical company.

Alcohol Addiction Treatment Firm will be Banned from Disclosing Health Data for Advertising to Settle FTC Charges that It Shared Data Without Consent

The Federal Trade Commission has taken action against an alcohol addiction treatment service for allegedly disclosing users’ personal health data to third-party advertising platforms, including Meta and Google, for advertising without consumer consent, after promising to keep such information confidential.

CMS Proposes New Policies to Support Underserved Communities, Ease Drug Shortages, and Promote Patient Safety

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule updating Medicare payments and policies for inpatient hospitals and long-term care hospitals.

Owner of Telemedicine Companies Pleads Guilty to $110 Million Medicare Fraud Scheme

The owner of Expansion Media (Expansion) and Hybrid Management Group (Hybrid) pleaded guilty in connection with a $110 million telemedicine fraud scheme involving medically unnecessary durable medical equipment (DME), including orthotics such as back and knee braces.

Former Healthcare Executive Director Indicted for Mail Fraud

Kevin Harrington, age 50, of Oneonta, New York, was arraigned on a federal indictment charging him with two counts of mail fraud, United States Attorney Carla B. Freedman and Craig L. Tremaroli, Special Agent in Charge of the Albany Field Office of the Federal Bureau of Investigation (FBI) announced.

HHS Notice of Benefit and Payment Parameters for 2025 Final Rule

In the U.S. Department of Health and Human Services (HHS) Notice of Benefit and Payment Parameters (Payment Notice) for 2025 final rule released, the Centers for Medicare & Medicaid Services (CMS) finalized standards for issuers and Marketplaces, as well as requirements for agents, brokers, web-brokers, direct enrollment entities, and assisters that help Marketplace consumers. This […]

Biden-Harris Administration Finalizes Rule Expanding Access to Care and Increasing Protections for People with Medicare Advantage and Medicare Part D

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is finalizing policies that continue to strengthen enrollee protections and guardrails to ensure Medicare Advantage and Medicare Part D (Part D) prescription drug plans best meet the needs of people with Medicare.

HHS Finalizes Policies to Make Marketplace Coverage More Accessible and Expand Essential Health Benefits

The Biden-Harris Administration, through the U.S. Department of Health and Human Services (HHS)’s Centers for Medicare & Medicaid Services (CMS), announced policies for the Affordable Care Act Marketplaces that make it easier for low-income people to enroll in coverage, provides states the ability to increase access to routine adult dental services, and sets network adequacy standards for the time and distance people travel for appointments with in-network providers.

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