tldrdailynews.com logo
Tag

Medicare

All articles tagged with #medicare

HealthSplash Founder Convicted in $1B Medicare Fraud Conspiracy
crime12 days ago

HealthSplash Founder Convicted in $1B Medicare Fraud Conspiracy

A federal jury in the Southern District of Florida convicted Brett Blackman, founder and owner of HealthSplash, of leading a scheme that used DMERx to generate false doctor’s orders and prescriptions to bill Medicare and other federal programs for more than $1 billion in medically unnecessary durable equipment and related items, aided by foreign call centers and kickbacks. The co-conspirators billed for sham orders, and Blackman faces up to 20 years for conspiracy to commit health care and wire fraud, plus additional terms for kickbacks and false statements; sentencing is set for August 26, 2026. The case was pursued by multiple agencies as part of the Health Care Fraud Strike Force effort that has charged thousands since 2007.

via Department of Justice (.gov)|
#crime#health-care-fraud#healthsplash
Six-Month Medicare Moratorium Halts New Hospice Enrollments to Fight Fraud
politics12 days ago

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
Vance Threatens Health-Funding Cuts Over State Anti-Fraud Compliance
politics12 days ago

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
Six-month Medicare enrollment freeze targets hospice and home health to curb fraud
politics13 days ago

Six-month Medicare enrollment freeze targets hospice and home health to curb fraud

The Trump administration's CMS announced a six-month nationwide moratorium on new Medicare enrollments for hospice and home-health agencies to thwart fraud, while continuing investigations and removals of fraudulent providers; existing providers remain in operation, and the move is part of a broader anti-fraud push led by VP JD Vance, amid concerns about access and potential impacts on compliant providers.

via AP News|
#cms#healthcare-fraud#home-health
Trump’s Drug-Pricing Push Delivers Some Discounts, But Prices Climb for Many
healthcare19 days ago

Trump’s Drug-Pricing Push Delivers Some Discounts, But Prices Climb for Many

Trump’s drug-pricing efforts have yielded uneven gains: Medicare's negotiated discounts cut some prices and cap out-of-pocket costs, and TrumpRx offered notable cuts on certain brand drugs, but overall about 1,000 branded drugs rose in price in early 2026, and benefits mostly reach cash-paying patients, with many discounts opaque and limited in scope; experts say the policy changes do not broadly reshape drug pricing.

via CBS News|
#biosimilars#drug-prices#healthcare
politics28 days ago

GOP targets hospital cost crisis as Smith grills CEOs at Ways and Means

At a Ways and Means hearing, Rep. Jason Smith criticized hospital CEOs for profits and mergers and threatened to cut Medicare payments under a site-neutral policy, highlighting Republicans’ focus on rising healthcare costs even as Democrats warn about Medicaid cuts; the broader Capitol Hill round-up includes battles over pesticide labeling in the farm bill, Rep. Daniel Webster’s retirement, and ongoing GOP wrangling on FISA and the budget, all amid King Charles III’s visit to Congress.

via Politico|
#congress#farm-bill#healthcare
health-policy1 month ago

RAPID Pathway Aims to Fast-Track Medicare Coverage for Breakthrough Devices

CMS and FDA unveiled the RAPID coverage pathway to align FDA market authorization with Medicare national coverage decisions for eligible Breakthrough Devices (Class II and III). The program enables early, coordinated engagement with manufacturers, uses the FDA's market authorization to trigger a proposed NCD the same day, includes a 30‑day public comment period, and aims for coverage as soon as two months after FDA approval. The Transitional Coverage for Emerging Technologies (TCET) pathway will be paused to focus on RAPID, and a procedural notice will be published in the Federal Register for public input.

via Centers for Medicare & Medicaid Services | CMS (.gov)|
#breakthrough-devices#fda#health-policy
Medicare pauses BALANCE GLP-1 pilot as transitional coverage extends through 2027
health1 month ago

Medicare pauses BALANCE GLP-1 pilot as transitional coverage extends through 2027

The Trump administration indefinitely delays the BALANCE pilot that would have let private Medicare drug plans cover GLP-1 weight-loss medicines, after insurers voiced concerns, while a transitional program will cover the drugs through 2027 with Medicare bearing the cost and no requirement for plans to take on financial risk. This means $50 co-pays won’t count toward deductibles or out-of-pocket max for the time being. The Medicaid portion of the initiative continues, with states able to apply by July 31, and analysts see the move as buying time to reassess BALANCE while keeping access available for beneficiaries.

via Axios|
#balance#glp-1#health
Medigap price hikes surge, leaving seniors with few affordable options
health1 month ago

Medigap price hikes surge, leaving seniors with few affordable options

Medigap premiums are rising sharply across major insurers, with 2026 plan filings showing Plan G increases from roughly 12% to 26% and some policyholders hit by abrupt, double-digit jumps (including a 45% jump that affected dozens of clients). Brokers say higher costs are driven by more medical use, aging beneficiaries, and higher claims. Options to manage costs include choosing plans with deductibles, moving to Medicare Advantage (which has out‑of‑pocket caps but network limits), or using state birthday rules to switch plans; Congress’ ability to cap out-of-pocket costs remains uncertain.

via CBS News|
#health#health-policy#medicare
Pickleball Injury Casts Light on California Hospice Fraud
politics1 month ago

Pickleball Injury Casts Light on California Hospice Fraud

At a House Ways and Means Committee hearing, Lynn Ianni described how a stolen Medicare ID enrolled her in hospice and denied treatment for a pickleball injury, illustrating a broader California hospice fraud scheme involving fake claims and stolen physician identities; despite a licensing moratorium and hundreds of hospice suspensions in Los Angeles, regulators say reforms lag and fraud persists, signaling a nationwide Medicare integrity challenge.

via Los Angeles Times|
#california#congressional-hearing#fraud-prevention
Court Dismisses Anti-Hemp Suit Over Medicare CBD Coverage for Lack of Standing
health1 month ago

Court Dismisses Anti-Hemp Suit Over Medicare CBD Coverage for Lack of Standing

Federal health officials asked a court to dismiss a lawsuit by anti-cannabis groups led by SAM and a Medicare patient challenging CMS’s voluntary hemp-derived products coverage under Medicare, arguing the plaintiffs lack Article III standing and that the BEI component is not a new entitlement. The policy allows hemp-derived products (CBD) with up to 0.3% delta-9 THC and up to 3 mg total THC per serving, and is funded by providers up to a $500 annual cap per beneficiary. Plaintiffs contend the program diverts resources and harms their goals, but the government says there is no injury and no rulemaking required for this voluntary model. The case may seek to add MMJ as plaintiffs, a TRO was previously denied, and the matter continues to hinge on federal hemp vs. marijuana policy.

via Marijuana Moment|
#cbd#health#hemp
GOP Pushes Constitutional Amendment That Could Erode Medicare and Social Security
politics2 months ago

GOP Pushes Constitutional Amendment That Could Erode Medicare and Social Security

Nearly every House Republican backed a proposed constitutional amendment that would bar federal deficit spending with a wartime exception, a move experts say would trigger deep cuts to Medicare, Social Security, nutrition programs and more. The final vote was 211-207, short of the two-thirds needed for ratification, with only one Democrat, Rep. Henry Cuellar, voting yes.

via Common Dreams|
#andy-biggs#deficit-spending#medicare
LA Hospice Cluster at One Plaza Triggers Fraud Flags
investigative-crime-and-public-safety2 months ago

LA Hospice Cluster at One Plaza Triggers Fraud Flags

CBS News documents a dramatic clustering of 89 licensed hospice firms in a single Van Nuys building (Merabi Plaza), a pattern auditors say raises red flags for fraud; 72 of the 89 show multiple warning signs such as multiple firms in one building, low patient counts, or excessive billing, and regulators have logged roughly 400 violations at 75 companies from 2021–2025; the building’s owner disputes the count, noting some tenants moved out, prompting concerns about ghost hospices while federal officials pledge ongoing Medicare scrutiny.

via CBS News|
#california-auditor#clustering#hospice-fraud