Tag

Cms

All articles tagged with #cms

health11 days ago•3 min saved

HHS flags suspected gender-affirming care billing across major providers

The Department of Health and Human Services announced referrals to federal investigators of hundreds of providers over potentially anomalous billing of gender-affirming care for minors, including about $50 million in claims from 2015–2025 and major hospitals among those named. The CMS-commissioned report cited patterns it says could financially benefit providers, while the administration continues to push policies to curb or end funding for such care, drawing criticism from major medical groups and ongoing regulatory actions.

via Fierce Healthcare|

#billing-practices #cms #gender-affirming-care

health-policy26 days ago•5 min saved

Judge lets Medicaid work-rule for chronically ill patients move forward, with future challenges possible

A federal judge declined to block the rule requiring chronically ill Medicaid beneficiaries to prove they can’t work to keep coverage, keeping the policy in place ahead of a Jan. 1 implementation as the broader legal challenge continues; injunction denied without prejudice, allowing renewed challenges if new harms surface, while doctors warn of administrative burdens and potential impacts on patient care.

via Politico|

#cms #health-policy #judge-richard-j-stearns

health1 month ago•5 min saved

CMS Freezes Over $1 Billion in Medicaid Funds in CA and MN Amid Fraud Probe

CMS announced deferrals totaling more than $1 billion in Medicaid funding to California ($867 million) and Minnesota ($199 million) due to suspected fraud, the latest move in a broader crackdown that has deferred over $2.5 billion this year. The withheld funds could be released if the states prove the claims were legitimate, with emphasis on high-risk in-home care services. Minnesota cites provider disenrollments after audits, while California argues the action saves taxpayers; critics call it politically driven and lacking transparency into how deferral amounts are calculated. This is Minnesota’s third deferral and accompanies a broader fraud-fighting push ahead of the 2026 midterms.

via Politico|

#california #cms #fraud

healthcare1 month ago•2 min saved

White House Proposes Hospital-Doctor Imaging Payment Parity

The White House proposed a rule to cut hospital payments for routine imaging services (X-rays, ultrasounds, MRIs) to level with what doctor’s offices are paid, aiming to save about $9.5 billion for the Medicare trust fund over a decade (the CBO estimates about $7.6 billion in savings). The rule would apply to most scans except contrast-enhanced procedures, would take effect January 1, and is open to public comment before finalization. Proponents say site-neutral payments curb healthcare spending, while hospitals argue they cover more complex patients and higher overhead. This continues prior site-neutral efforts, including recent moves on off-campus drug administration.

via News of the United States - NOTUS|

#cms #healthcare #hospitals

health1 month ago•14 min saved

States sue over federal Medicaid work rules in sweeping multi-state lawsuit

Nearly half of U.S. states filed a multi-state lawsuit against the federal government over Medicaid work requirements, arguing the rules exceed federal authority and could reduce coverage; the suit challenges CMS’s authority to condition Medicaid eligibility on work or community engagement, highlighting a broader political fight over tying welfare programs to work requirements.

via AP News|

#cms #federal-state-relations #health

health-policy1 month ago•3 min saved

Medicare to require hospitals to log end-of-life preferences in electronic records by 2028

Medicare proposes hospitals begin recording adults’ end-of-life care preferences (including DNR orders and designated decision-makers) in electronic health records by 2028, with these preferences part of quality metrics that could affect reimbursements from 2030. The goal is to normalize advance care planning and reduce unwanted, costly interventions, though providers warn about added burden and studies show mixed effects on care and outcomes.

via Axios|

#advance-directives #cms #electronic-health-records

health2 months ago•2 min saved

CMS Maps Exemptions in Medicaid Work Rules

CMS guidance exempts pregnant women, parents of young children, veterans with disabilities, and other medically frail individuals from the new Medicaid work rules; most adults must meet an 80-hour-per-month work/education/volunteering requirement to keep coverage, with self-attestation allowed in year one and formal verification beginning in 2028. Homeless individuals are not exempt. States decide medical exemptions, raising fraud and administration concerns, as some projections warn millions could lose coverage by 2034 due to paperwork and system hurdles, while officials say the rule aims to boost employment.

via NBC News|

#cms #exemptions #health

policy3 months ago•6 min saved

Minnesota Medicaid fraud indictment: 15 charged in $90 million autism services scheme

The Department of Justice indicted 15 Minnesotans for a $90 million Medicaid fraud scheme tied to autism services. CMS has withheld Medicaid payments over fraud concerns, and Minnesota plans to revalidate high‑risk providers as part of a broader crackdown, highlighting tensions between the Trump administration and state oversight of federal funds.

via Politico|

#autism-services #cms #doj

technology3 months ago•3 min saved

Drupal unveils urgent core patch to curb high-risk exploit

Drupal has issued a critical core security release to fix a high-exploitation vulnerability affecting Drupal 8 and newer. Administrators should plan to apply the update on May 20 UTC, upgrading to at least Drupal 10.6 or using hotfixes for older 9.x/8.x where available. Patches are released for 11.3.x, 11.2.x, 11.1.x, 10.6.x, 10.5.x, and 10.4.x; Drupal 8/9 are end-of-life and won’t receive patches, though hotfixes will be published for 9.5 and 8.9. Drupal Steward customers are protected but should still update. No technical vulnerability details are disclosed yet; admins should monitor Drupal’s security portal for official guidance.

via BleepingComputer|

#cms #cybersecurity #drupal

healthcare-policy3 months ago•2 min saved

Oz launches 29-member coalition to speed medical prior authorizations

Dr. Oz unveiled a 29-member coalition of insurers, hospitals, and health-records companies to streamline prior authorization for medical procedures, aiming for faster, more transparent decisions by next January. The move expands a trend of insurer pledges to reduce administrative burden, with groups like AtlantiCare, Bon Secours Mercy Health, and Cleveland Clinic on board. Medicare’s AI-powered pre-treatment reviews have begun in some states, while critics warn about persistent paperwork and calls in Congress to curb prior authorizations for Medicare Advantage. The effort signals ongoing pressure to simplify and standardize the process across providers and payers.

via Axios|

#cms #dr-oz #electronic-prior-authorization

politics3 months ago•3 min saved

Six-Month Medicare Moratorium Halts New Hospice Enrollments to Fight Fraud

The Trump administration announced a six-month moratorium on new Medicare enrollments for hospice and home-health agencies to curb fraud, with no new licenses issued while existing providers remain. CMS will conduct targeted investigations and speed up removal of suspected fraudsters, a move that follows prior probes into hospice fraud and Medicaid anti-fraud funding concerns across states.

via CBS News|

#cms #fraud #home-health

politics3 months ago•6 min saved

Fraud crackdown prompts $1.3B Medicaid deferral for California

The Trump administration defers $1.3 billion in California Medicaid payments as part of a broader anti-fraud push, including reviews of Medicaid Fraud Control Units and a six-month moratorium on new hospice and home-health provider enrollments; officials say the measures aim to curb fraud, but critics warn about potential access issues and question their effectiveness.

via CNN|

#california #cms #fraud

politics3 months ago•2 min saved

Trump administration withholds $1.3B in California Medicaid amid fraud crackdown

The Trump administration will withhold $1.3 billion in federal Medicaid payments to California, citing the state’s inadequate anti‑fraud efforts. Vice President JD Vance announced audits of state Medicaid fraud control units and warned funds could be lost, part of a broader push against fraud in public health programs that has already included halting $259 million in Minnesota funds and a six‑month moratorium on new hospice providers as CMS investigates the industry.

via The New York Times|

#california #cms #fraud

politics3 months ago•5 min saved

Vance Threatens Health-Funding Cuts Over State Anti-Fraud Compliance

Vice President JD Vance warned that federal Medicaid and Medicare funds could be turned off for states that do not aggressively tackle fraud, as CMS freezes new enrollments for hospice and home health agencies while it investigates; the move, part of a broader anti-fraud push, has drawn criticism that it could punish political rivals and threaten patient access, and its legal basis remains disputed.

via The Guardian|

#cms #fraud #medicaid

politics3 months ago•3 min saved

Federal Withholding of $1.3B in California Medicaid Signals Expanded Fraud Crackdown

Vice President JD Vance announced the administration will suspend $1.3 billion in California Medicaid payments and threatened to freeze funding for Medicaid Fraud Control Units in all states if fraud isn’t aggressively prosecuted; CMS chief Mehmet Oz cited red flags in California billing and announced a six-month moratorium on new Medicare enrollments for hospices and home health agencies as part of the anti-fraud push.

via NBC News|

#california #cms #fraud