Medicare Archives - HIT Leaders and News

Wound Care Fraud Settlement Exposes Deeper Risks in EHR-Driven Billing

Jason Free — Mon, 24 Nov 2025 17:54:18 +0000

The recent $45 million settlement between the U.S. Department of Justice and Vohra Wound Physicians marks more than a punitive action. It also surfaces a structural weakness in healthcare billing that leaders can no longer afford to overlook. Vohra, one of the largest providers of bedside wound care in skilled nursing facilities, was accused of engineering an internal system that used electronic health records (EHRs) and billing automation to systematically overcharge Medicare for unnecessary and sometimes unperformed surgical debridement procedures.

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Medicare Cost Stability Obscures Structural Uncertainty

Jason Free — Mon, 29 Sep 2025 11:32:53 +0000

The Centers for Medicare & Medicaid Services (CMS) recently announced that premiums and benefits for both Medicare Advantage (MA) and Medicare Part D will remain stable in 2026, with modest reductions in average monthly costs. On the surface, this announcement suggests program resilience and affordability.

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Value-Based Care Is Finally Coming for Specialists

Jason Free — Mon, 28 Jul 2025 11:53:18 +0000

For over a decade, Medicare's transition toward value-based reimbursement has primarily revolved around primary care physicians, care coordination infrastructure, and population health strategy. Models like the Medicare Shared Savings Program (MSSP) and ACO REACH have restructured incentives across thousands of organizations, but have left many high-volume specialists on the periphery.

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Why DME Fraud Is Still a Gaping Hole in Medicare Integrity

Jason Free — Thu, 12 Jun 2025 12:08:55 +0000

The sentencing of Michael G.V. Comino to 22 months in prison for conspiracy to pay and receive healthcare kickbacks underscores a stubborn truth in U.S. healthcare: durable medical equipment (DME) fraud remains a persistent and lucrative conduit for siphoning federal dollars from Medicare.

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Medicare’s Value-Based Transition Is at Risk Without Congressional Action, Say 550+ Healthcare Groups

Jason Free — Tue, 03 Jun 2025 12:16:25 +0000

More than 550 accountable care organizations, physician practices, hospitals, and healthcare stakeholders have delivered a clear and urgent message to congressional leaders: sustain Medicare’s transition to advanced alternative payment models (APMs) or risk derailing a decade’s worth of progress in value-based care.

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CMS Seeks Public Input on Improving Technology to Empower Medicare Beneficiaries

Jason Free — Tue, 13 May 2025 23:51:40 +0000

The Centers for Medicare & Medicaid Services (CMS) is taking bold steps to modernize the nation’s digital health ecosystem with a focus on empowering Medicare beneficiaries through greater access to innovative health technologies. The agency, in partnership with the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC), is seeking public input on how best to advance a seamless, secure, and patient-centered digital health infrastructure. The goal is to unlock the power of modern technology to help seniors and their families take control of their health and well-being, manage chronic conditions, and access care more efficiently.

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Massachusetts Doctor Agrees to Plead Guilty to $35.5 Million Medicare Fraud Scheme

Jason Free — Thu, 08 May 2025 10:27:19 +0000

According to the charging documents, from in or about March 2017 through in November 2020, Thu knowingly and willfully engaged in a scheme to deceive the Medicare Program in connection with payments for genetic testing for beneficiaries. Specifically, Thu allegedly signed and/or caused other individuals who had no medical training to sign and submit false medical documentation and orders for beneficiaries’ genetic testing – which was generally not covered by Medicare – therefore making it appear that Thu was providing legitimate services. Thu allegedly signed or caused these orders to be signed that falsely claimed she had consulted with beneficiaries, conducted examinations prior to ordering genetic testing, obtained consent, and/or would use the testing results to treat the beneficiaries.

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Jury Convicts Florida Man For Stealing $10.9 Million From Medicare

Jason Free — Tue, 06 May 2025 10:31:11 +0000

United States Attorney Gregory W. Kehoe announces that a federal jury has found Lino Mallari Gutierrez (59, Palm City), a/k/a “Joe Gutierrez,” guilty of conspiracy to commit health care and wire fraud, conspiracy to violate the federal anti-kickback statute, five substantive counts of health care fraud, and four substantive counts of payment of kickbacks in connection with a heath care program. After the jury verdict, the court remanded Gutierrez into custody. Gutierrez faces a maximum penalty of 20 years in federal prison.

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Reversing the Decline: Inside the Fight to Fix Medicare Physician Pay

Jason Free — Tue, 29 Apr 2025 11:59:28 +0000

As the fifth consecutive year of Medicare physician payment cuts takes effect, physician groups are warning of cascading access issues, especially in rural and underserved markets. While Congress debates whether to reverse the latest 2.83% reimbursement cut, the broader conversation has shifted: Can the Medicare Physician Fee Schedule be fixed before it irreparably breaks independent practice?

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Site-Neutral Payments: The Bipartisan Policy Threat Hospital IT Teams Can’t Ignore

Jason Free — Wed, 23 Apr 2025 10:44:43 +0000

A quiet but powerful policy shift is gaining traction in Congress, and it has hospital CFOs, revenue cycle leaders, and IT teams on alert: site-neutral Medicare payments. Promoted as a cost-saving strategy with bipartisan appeal, site-neutrality would eliminate the payment differential between hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) or physician offices for the same services.

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