Showing posts with label medicare. Show all posts
Showing posts with label medicare. Show all posts

Friday, June 30, 2023

DME Fraud - Crime Doesn't Pay

According to the article:

  • "Tamara Yvonne Motley, 54, a.k.a. “Tamara Ogembe,” of Redondo Beach, Calif., was found guilty of nearly two dozen felonies for billing Medicare more than $24 million by submitting fraudulent claims for medically unnecessary durable medical equipment – mostly power wheelchairs and repairs, many of which were never performed." 
  • "Anthony Duane Bell, Sr., of El Cajon, Calif., has pleaded guilty to fraudulently receiving more than $21 million in Medicare payments. His son, Anthony Duane Bell, Jr., admitted making false statements to the FBI to conceal the fraudulent scheme." ... "The companies supplied durable medical equipment like knee, ankle, wrist, shoulder and back braces."

Read the full source article: California Fraud Watch:  Guilty Verdict In Redondo Beach - HME News

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Sunday, August 9, 2020

Using Medicare Accreditation To Make A Difference With Private Pay Insurance: HME-Business

In a nutshell:

Providers need accreditation to bill Medicare, but it's critical in HME businesses' overall market strategy for working with private payers, as well. What do providers need to keep in mind?

According to the article:

  • "After years of largely accepting the accreditation requirement, private payers have begun to scrutinize what product categories providers are accredited for when making decisions about valuable contracts.
  • As the HME industry weathers the storm of the COVID-19 pandemic, demonstrating compliance and emergency preparedness policies to private payers will become more crucial in standing out in the marketplace.
  • Accrediting organizations have created programs specifically targeted at proving expertise in product categories such as oxygen, home infusion, pharmacy and more."

Read the full source article:  Using Medicare Accreditation To Make A Difference With Private Pay Insurance: HME-Business

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California Exemptee Training Certification - for home medical device retailers.  If you are applying for a California Exemptee license, you'll need to include proof of required training in your application. Take this online course to earn a course completion certificate for your license application.


For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Monday, September 9, 2019

[DME] Providers feel burned in California - HME News

Read the full article:  [DME] Providers feel burned in California: Under a proposal, Medi-Cal reimbursement for an oxygen concentrator would drop to $55.19 - HME News

"California’s Medicaid program, Medi-Cal, may find itself in a bind for HME providers if a drastic reimbursement cut goes through as planned, say industry stakeholders. 
To comply with the 21st Century Cures Act, the Department of Health Care Services has proposed paying 80% of Medicare’s non-rural fee schedule amounts for most DME. For providers in the state, who are currently reimbursed at the 2016 Medicare fee schedule amounts, that’s a cut of up to 60%."

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California HMDR Exemptee online training certification class for home medical device retailers. Earns a course completion certificate accepted by the California Department of Public Health. $525 per student.
California HMDR Exemptee online training certification class for home medical device retailers. Earns a course completion certificate accepted by the California Department of Public Health. $525 per student.



For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Tuesday, June 18, 2019

A Scary New Trend: Six-Year Lookback Audits - HME Business

The full article is a must read:  A SCARY NEW TREND: SIX-YEAR LOOKBACK AUDITS - Understanding another 'new normal' for HMEs from HHS OIG. - HME Business

"The Office of Inspector General (OIG) regularly performs audits and reviews as part of its normal functions. In June 2018, it released a scathing report entitled, “Most Medicare Claims for Replacement Positive Airway Pressure Device Supplies Did Not Comply With Medicare Requirements.”"  ... 
"In layman’s terms, suppliers either have to review every claim they have submitted for PAP supplies for the previous six years, or they must identify the universe of claims by taking a statistically valid random sample and extrapolating the results of the audit once the sample has been reviewed. They are asking suppliers to do something that requires the high-level skills and knowledge of an expert statistician."

#HMDRexemptee #HMDR #HME #DME #CPAP

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California Home Medical Device Retail Exemptee Online Training Certification Course - accepted by the California Department of Public Health (Food and Drug Branch)
California Home Medical Device Retail Exemptee Online Training Certification Course - accepted by the California Department of Public Health (Food and Drug Branch)


For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Tuesday, April 16, 2019

Dozens Charged in Massive DME Fraud Scheme Worth More than $1 Billion - HomeCareMag.com

Read the full article:  Dozens Charged in Massive DME Fraud Scheme Worth More than $1 Billion - HomeCareMag.com

"The defendants allegedly participated in health care fraud schemes involving more than $1.2 billion in loss. The Center for Medicare Services’ Center for Program Integrity also announced today that it took administrative action against 130 DME companies that had submitted more than $1.7 billion in claims, netting more than $900 million in payments."

Learn more about the fraud scheme:

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For home medical device retailers - California HMDR Exemptee - Online training certification course. Earns a completion certificate accepted by the California Department of Public Health (Food & Drug Branch).
For home medical device retailers - California HMDR Exemptee - Online training certification course. Earns a completion certificate accepted by the California Department of Public Health (Food & Drug Branch).

For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Friday, February 1, 2019

New App Displays What Items Medicare Covers - HME Business

Updated June 11, 2026

You might also like:

What's covered? - Medicare.gov:
https://www.medicare.gov/coverage

---  the original post follows below  ---

Read the full article:  New App Displays What Items Medicare Covers - HME Business 

"CMS has launched What’s Covered, a new smart phone app that lets beneficiaries with Original Medicare, caregivers and other healthcare professionals quickly check whether an item or service is covered by Medicare. 
What’s covered is intended to bypass what CMS predicts will be a gigantic avalanche of coverage questions in coming decades."

Get the What's Covered app for free:

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California HMDR Exemptee Training Certification Course for home medical device retailers (accepted by the California Department of Public Health - Food and Drug Branch)
California HMDR Exemptee Training Certification Course for home medical device retailers (accepted by the California Department of Public Health - Food and Drug Branch)


For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Friday, June 29, 2018

Most Medicare Claims for Replacement PAP Device Supplies Didn't Comply With Medicare Requirements - OIG

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California HMDR Exemptee Training Certification:

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Read the full June 2018 report:

Most Medicare Claims for Replacement Positive Airway Pressure Device Supplies Did Not Comply With Medicare Requirements - DHS OIG (PDF - click this link)

"Most Medicare claims that DME suppliers submitted for replacement PAP device supplies did not comply with Medicare requirements. Of the 110 claims in our sample, 24 complied with Medicare requirements; however, 86 claims with payments totaling $13,414 did not. On the basis of our sample results, we estimated that Medicare made overpayments of almost $631.3 million for replacement PAP device supply claims that did not meet Medicare requirements."

The CMS expressed interest in educating health care providers on avoiding Medicare billing errors.

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Training for HMDR Exemptee license applicants - Earn a course completion certificate - Accepted by the California Dept of Public Health (CDPH)


For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Monday, December 4, 2017

Policymakers must fix problems with Medicare’s competitive bidding program for home oxygen therapy | The Hill

Read the full article:  Policymakers must fix problems with Medicare’s competitive bidding program for home oxygen therapy | The Hill:

"The end result is that patients are finding it more difficult to access the treatments they need.  According to Medicare’s data, the number of oxygen rental patients declined by 33 percent between 2008 and 2014, while the number of COPD diagnoses increased by 59 percent. Because the only treatment for COPD in its later stages is home oxygen therapy, the increase in diagnosis and the decrease in patients using the services suggests that patients aren’t getting access to the care necessary to remain at home."

'via Blog this'

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Training program for home medical device retailers applying for a California Exemptee license - Earn a course completion certificate

- - -

For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Monday, July 17, 2017

First Quarter HME Audit Key Report Released | HomeCare Magazine

HME Audit Key Report

Read the whole article: First Quarter HME Audit Key Report Released | HomeCare Magazine:

"The latest HME Audit Key survey results, running through the first quarter of 2017, show continued appeal determinations in favor of suppliers in several product categories, including overturn rates of 68 percent for respiratory products, 77 percent for ostomy, urological, wound care, and diabetic supplies, and 81 percent for NPWT devices and supplies. Other highlights from this round include:"
. . .

'via Blog this'

Read the report mentioned above:
Examining the Impact of Medicare - Audits on HME Suppliers

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Training program for California Home Medical Device Retailer (HMDR) Exemptee license applicants

CA HMDR Exemptee online internet-based training certification by SkillsPlus Intl Inc.
The Exemptee Institute

NEW! CA Designated Representative-3PL online training certification by SkillsPlus Intl Inc.- We'll send you the 3PL training affidavit upon successful course completion.
CA Designated Representative online web-based training certification by SkillsPlus Intl Inc. - Available around-the-clock 24 x 7
FL Certified Designated Representative (CDR) online exam prep course - Lots of practice exams - Practice makes perfect!
The Designated Representative Institute

Tuesday, June 6, 2017

Medicare: Fix Payment Methodologies That Put Senior Care at Risk - Morning Consult

Read the full opinion: Medicare: Fix Payment Methodologies That Put Senior Care at Risk - Morning Consult:

"But if chronic cuts, under reimbursement, and failure to apply appropriate funding methodologies continue, rather than receive services at home, patients will certainly be forced to a hospital or other institutional settings — resulting in significantly higher costs to Medicare and counteracting the program’s current goals of improving value and reducing hospitalizations."

'via Blog this'

Return Home:  The Designated Representative and Exemptee Blog

Training program for California HMDR Exemptee license applicants
CA HMDR Exemptee online internet-based training certification by SkillsPlus Intl Inc.
The Exemptee Institute

NEW! CA Designated Representative-3PL online training certification by SkillsPlus Intl Inc.- We'll send you the 3PL training affidavit upon successful course completion.
CA Designated Representative online web-based training certification by SkillsPlus Intl Inc. - Available around-the-clock 24 x 7
FL Certified Designated Representative (CDR) online exam prep course - Lots of practice exams - Practice makes perfect!
The Designated Representative Institute

Thursday, April 13, 2017

Op-Ed: Medicare's Wrong Approach to Home Oxygen Therapy | Medpage Today

Read the full article: Op-Ed: Medicare's Wrong Approach to Home Oxygen Therapy | Medpage Today:

"So why is home oxygen care on the decline when the number of Americans who need it is rising? The answer is a complicated result of a host of policy changes over the past several years."

'via Blog this'

Training program for CA HMDR Exemptee license applicants


Return Home:  The Designated Representative and Exemptee Blog

For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Friday, September 16, 2016

Medicaid fraud unit secures millions in recoveries | HME News

Updated June 11, 2026

You might also like:
    Medicaid Fraud Control Units - OIG:
    https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/

--  the original post follows below  ---

Read the full article: Medicaid fraud unit secures millions in recoveries | HME News:

"Medicaid Fraud Control Units in 2015 obtained 1,553 criminal convictions and 731 civil settlements and judgments for provider fraud and patient abuse and neglect, according to a new report from the Office of Inspector General."

'via Blog this'

Read the report:
Medicaid Fraud Control Units - Fiscal Year 2015 Annual Report - U.S. Department of Health and Human Services, Office of Inspector General (PDF)

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For CA Home Medical Device Retailer (HMDR) Exemptee license applicants



For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Tuesday, July 12, 2016

Medicare Cuts Will Disproportionately Harm COPD Patients - Morning Consult


Read the full article: Medicare Cuts Will Disproportionately Harm COPD Patients - Morning Consult:

"CMS has chosen to deeply reduce Medicare payments for the home oxygen services required to keep COPD patients healthy and out of the hospital and other costly facilities.  On January 1, CMS began applying the competitive bid rates used in urban areas to rural and other non-competitive bid areas.  This policy is being phased-in over only a 6-month period, taking full effect on July 1 and resulting in a 30-50 percent cut to home respiratory therapy. Additionally, another set of cuts of approximately 18 percent was just applied on July 1."

'via Blog this'

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For CA Home Medical Device Retailer (HMDR) Exemptee license applicants


CA HMDR Exemptee online internet-based training certification by SkillsPlus Intl Inc.
The Exemptee Institute

NEW! CA Designated Representative-3PL online training certification by SkillsPlus Intl Inc.- We'll send you the 3PL training affidavit upon successful course completion.
CA Designated Representative online web-based training certification by SkillsPlus Intl Inc. - Available around-the-clock 24 x 7
FL Certified Designated Representative (CDR) online exam prep course - Lots of practice exams - Practice makes perfect!
The Designated Representative Institute

Wednesday, June 1, 2016

Big Data Tool Saves CMS $1.5B by Preventing Medicare Fraud - RevCycle Intelligence

Updated February 2, 2026

The original link broke.

You can still read about the same topic here:

‘Big data’ effort saves $1.5B in Medicare fraud - Healthcare Dive:
https://www.healthcaredive.com/news/big-data-effort-saves-15b-in-medicare-fraud/419996/

--   the original post follows below  ---

Read the full article: Big Data Tool Saves CMS $1.5B by Preventing Medicare Fraud - RevCycle Intelligence:

"Using big data tools and predictive analytics, the Centers for Medicare and Medicaid Services (CMS) has saved approximately $1.5 billion by preventing Medicare fraud in the traditional fee-for-service program, according to the official CMS blog.

Since June 2011, CMS has employed the Fraud Prevention System, which is a predictive analytics tool that identifies fraudulent claims and illegitimate Medicare payments. The tool analyzes about 4.5 million Medicare pre-paid claims each day to pinpoint potential issues before providers are paid."

'via Blog this'

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Enroll now to take this California Exemptee Training Certification Course - for home medical device retailers (HMDR)
Enroll now to take this California Exemptee Training Certification Course - for home medical device retailers (HMDR)

For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Tuesday, March 22, 2016

Medicare competitive bidding system led to increased mortality, hospitalization for diabetes - Healio

Read the short summary: Medicare competitive bidding system led to increased mortality, hospitalization for diabetes - Healio:

"Medicare’s Competitive Bidding Program for diabetes supplies disrupted beneficiaries’ ability to access diabetes testing equipment, leading to an increase in mortality, hospitalization rates and inpatient costs, according to a recent analysis by the National Minority Quality Forum."

'via Blog this'

View the journal abstract:
Impact of CMS Competitive Bidding Program on Medicare Beneficiary Safety and Access to Diabetes Testing Supplies: A Retrospective, Longitudinal Analysis

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For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Thursday, June 18, 2015

Authorities arrest 243 people in $712 million Medicare fraud | Reuters


Read the full article: UPDATE 2-Authorities arrest 243 people in $712 million Medicare fraud | Reuters:

"Many of the arrests were in Florida, long an epicenter of Medicare fraud. In Miami, 73 defendants were charged with offenses involving approximately $263 million in false billings.

Other cities involved include Houston, Dallas and McAllen, Texas; Los Angeles; Detroit; Tampa; Brooklyn, New York; and New Orleans."

'via Blog this'

Return Home:  The Designated Representative and Exemptee Blog

CA HMDR Exemptee online internet-based training certification by SkillsPlus Intl Inc.
The Exemptee Institute

NEW! CA Designated Representative-3PL online training certification by SkillsPlus Intl Inc.- We'll send you the 3PL training affidavit upon successful course completion.
CA Designated Representative online web-based training certification by SkillsPlus Intl Inc. - Available around-the-clock 24 x 7
FL Certified Designated Representative (CDR) online exam prep course - Lots of practice exams - Practice makes perfect!
The Designated Representative Institute

Thursday, April 17, 2014

CMS readying for background checks | HME News

Updated October 3, 2021

You might also be interested in:

---  the original post follows below  ---

CMS readying for background checks | HME News:

"Once fully implemented, the background checks will be completed on all individuals with a 5% or greater ownership interest in a provider that falls under the high-risk category. This category applies to DME and home health and hospice providers who are newly enrolling in Medicare, and those who have been elevated to the category in accordance with enrollment screening regulations."

'via Blog this'

Return Home:  The Designated Representative and Exemptee Blog

- - -

For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Thursday, March 27, 2014

Pharmacy fraud spreads through Florida, cheating Medicare - Sun Sentinel

Pharmacy fraud spreads through Florida, cheating Medicare - Sun Sentinel:

"In South Florida, the Part D investigative caseload has almost quadrupled over the past five years, Martens told the committee.

In one such case, a Miami Lakes man, his wife and mother were accused last year of dealing in pharmaceuticals that were diverted from Medicare, including more than $26 million of drugs sold to retail pharmacies in 18 states."

'via Blog this'

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FL Certified Designated Representative - CDR Exam Prep Course


Return Home:  The Designated Representative and Exemptee Blog

For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Friday, March 21, 2014

Contractors warn docs of DME scams | HME News

Contractors warn docs of DME scams | HME News:

"Common scams, according to the letter: unsolicited orders for medical equipment or supplies, often claiming a patient asked the supplier to contact the doctor; advertisements saying Medicare will pay physicians for patient referrals; and pre-completed medical necessity forms with instructions to sign and date.

The medical directors have asked doctors to pay careful attention to orders asking for their signatures. They recommend that doctors be skeptical of unsolicited orders for patients no longer in their practices and document medical justification for any DME item ordered for a patient."

'via Blog this'

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- - -

For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

Monday, February 24, 2014

As Home IVs Grow, Medicare Patients Miss Out - WSJ.com


As Home IVs Grow, Medicare Patients Miss Out - WSJ.com:

"Growing numbers of patients needing intravenous medications are getting their treatments at home. But a gap in Medicare coverage is making it harder for older and sicker patients to swap hospital stays for home care.

Hundreds of new intravenous drugs and biologic products have come on the market in recent years to treat maladies such as infections, cancer and chronic diseases. Administering these medications at home generally costs $150 to $200 a day, far below the $1,500-to-$2,500-a-day cost of a typical inpatient hospital stay. Home-infusion therapy also eliminates the risk that patients will be exposed to infections caused by hospital bacteria that can invade through IV lines and catheters."

'via Blog this'

Return Home:  The Designated Representative and Exemptee Blog

- - -

For Designated Representative license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training affidavit):
     Florida:

For HMDR Exemptee license applicants  -  Training programs, courses, classes, seminars:

     California (earn a training completion certificate):

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