News & Analysis as of

Medicare Durable Medical Equipment Centers for Medicare & Medicaid Services (CMS)

Sheppard Mullin Richter & Hampton LLP

Major Policy Changes Proposed for Medicare Payment, Accreditation, and Prior Authorization for DME Suppliers

Comments are due in less than a month on the Centers for Medicare & Medicaid Services (“CMS”) proposals to make significant structural reforms to Medicare’s Competitive Bidding Program (“CBP”) for Durable Medical Equipment,...more

Katten Muchin Rosenman LLP

Potential Changes Coming to Medicare Provider Enrollment and DMEPOS Accreditation

Often there is a lot of attention paid to the Centers for Medicare & Medicaid Services (“CMS”) Inpatient Prospective Payment System (“IPPS”), Outpatient Prospective Payment System (“OPPS”), and Medicare Physician Fee Schedule...more

McDermott Will & Schulte

Healthcare Regulatory Check-Up Newsletter | April 2025 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights regulatory activity for April 2025, including Centers for Medicare & Medicaid Services (CMS) updates to Medicare Advantage (MA) and other Medicare programs....more

Foley & Lardner LLP

Medicare: Prescriptions Now May Be Used to Support Medical Necessity of Durable Medical Equipment

Foley & Lardner LLP on

On September 26, 2024, the Centers for Medicare & Medicaid Services’ (CMS) Durable Medical Equipment (DME) Medicare Administrative Contractors (DME MACs), Noridian Healthcare Solutions, LLC and CGS Administrators, LLC,...more

McGuireWoods LLP

Ounce of Prevention: Do You Know When Your DMEPOS Surety Bonds Expire?

McGuireWoods LLP on

Applicable Provider Types: Any individual or entity that receives Medicare reimbursement for selling or renting DMEPOS - Is Your Entity in Compliance? Most durable medical equipment, prosthetics, orthotics and...more

Hendershot Cowart P.C.

Doctors: Don’t Fall Victim To Telemedicine Fraud Schemes

Hendershot Cowart P.C. on

Telemedicine companies are supposed to facilitate medically necessary services to beneficiaries over the telephone via licensed medical professionals. In reality, however, many of these “telemedicine companies” are...more

Quarles & Brady LLP

New Year, New CMS Pharmacy/DMEPOS Regulations on Refill, Deactivation, Revocation & Revalidation

Quarles & Brady LLP on

It pays to look closely. Buried deep within a 205-page and 1230-page Federal Register final rules publication, the Centers for Medicare & Medicaid Services (“CMS”) initiated impactful changes for pharmacies and Durable...more

McDermott Will & Schulte

Remote Monitoring and Digital Therapies: CMS Updates Coverage and Payment Policies

McDermott Will & Schulte on

In recent years, the Centers for Medicare & Medicaid Services (CMS) has expanded payment for remote monitoring services in an effort to pay for non-face-to-face services that improve care coordination for Medicare...more

Foley & Lardner LLP

Medicare Revocations and Enrollment Denials: Proposed Rule Adds False Claims Act Judgments and Misdemeanors; Creates New “Stay of...

Foley & Lardner LLP on

Continuing a now annual tradition, the Centers for Medicare & Medicaid Services (CMS) has included expansions and enhancements to its authorities to deny enrollment or revoke a provider’s Medicare billing privileges...more

Venable LLP

HHS 2021 Semiannual Report to Congress Draws Attention to Genetic Testing, Durable Medical Equipment, and Opioid Disorder...

Venable LLP on

On June 6, 2022, the U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG), released its spring 2022 semiannual report to Congress. The semiannual report covers the period of October 1, 2021 to...more

McGuireWoods Consulting

Washington Healthcare Update - January 2022 #4

This Week in Washington: Senate HELP Committee Chair Patty Murray and Ranking Member Richard Burr Release Discussion Draft of Bipartisan Pandemic and Public Health Response Bill....more

Oberheiden P.C.

Seven Points to be Aware of for Durable Medical Equipment Company Compliance

Oberheiden P.C. on

Durable medical equipment (DME) is particularly important for many Medicare beneficiaries. However, companies that manufacture and sell DME need to be careful because there are strict federal regulations outlining almost...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 25. News Briefs: July 2020

Report on Medicare Compliance 29, no. 25 (July 13, 2020)  -  Ophthalmic Consultants PA in Sarasota, Florida, agreed to pay $4.8 million to settle false claims allegations that it billed Medicare and other federal payers...more

Holland & Knight LLP

Healthcare Law Update: February 2020

Holland & Knight LLP on

Neurosurgeons' Compensation in Top 10 Percent Nationwide Gives Rise to Stark Act and FCA Claims - In United States ex re. Bookwalter v. UPMC, 946 F. 3d 162 (3d Cir. 2019), the court ruled that the relators stated a Stark...more

Epstein Becker & Green

New Program Integrity Rule Expanding Medicare Revocation and Denial Authorities Took Effect Yesterday

Epstein Becker & Green on

Yesterday, a final rule issued by the Centers for Medicare & Medicaid Services (CMS) establishing new enforcement initiatives aimed at removing and excluding previously sanctioned entities from Medicare, Medicaid, and the...more

Williams Mullen

Civil Investigative Demands and ZPIC Audits Can Be Traps for the Unwary

Williams Mullen on

Many people reasonably expect that when the government is targeting a company or individual for some adverse action, they will know it—there will be a lawsuit, an indictment, or some other clear demarcating event. ...more

Alston & Bird

Alston & Bird Healthcare Week in Review

Alston & Bird on

Alston & Bird’s Week in Review provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and Congressional committee action; reports, studies, and analyses; and other health...more

Arnall Golden Gregory LLP

CMS Reminds Providers and Suppliers of Reporting Requirements

The Centers for Medicare & Medicaid Services (CMS) recently released a new Medicare Learning Network “MLN Matters” education document to remind applicable providers and suppliers about the need to timely report provider...more

Faegre Drinker Biddle & Reath LLP

Qualifications for Artificial Limb Suppliers, After Only 16 Years

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

Arnall Golden Gregory LLP

“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

K&L Gates LLP

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

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

Baker Donelson

CMS's Payment Suspensions Wreak Havoc: Understanding the Risks

Baker Donelson 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

King & Spalding

OIG Urges CMS to Change Medicare Infusion Drug Payments

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

McDermott Will & Emery

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

Arnall Golden Gregory LLP

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

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