Category: Health Policy and Economics

Health Policy and Economics

Medicare Advantage Regional Pullbacks

  Medicare Advantage plan exits 2026 are shrinking rural coverage, with UnitedHealthcare and Humana leaving more counties than they enter, impacting patients…by Reginald Hislop, III Over the past several years the Medicare Advantage story has…

Health Policy and Economics

Wednesday Feature: Fraud Recap

Recent healthcare billing fraud cases show similar conduct moving across bill coding, DME, telemedicine, and product billing. Read the provider-level analysis….by Reginald Hislop, III Earlier this week I wrote about CMS barring eleven medical…

Health Policy and Economics

CMS Cracks Down on $3.4B DME Fraud

  CMS announced a $3.4 billion medical equipment supplier fraud scheme involving 11 suppliers and claims for deceased beneficiaries. Here is what it means….by Reginald Hislop III On September 8, 2026, CMS announced that it…

Health Policy and Economics

Senior Living Pressure: Rising Rates & Yields

Interest rates on government bonds worldwide are rising fast. Rising rates and rising bond yields do not stay inside the financial pages. They create ripple effects through mortgage rates, auto loans, and the loans that…

Health Policy and Economics

Medicare Advantage Fraud: Villages and Kaiser

Medicare Advantage plans are paid through risk adjustment. The government sends each plan a fixed monthly amount per enrollee, and that amount rises when the enrollee’s record contains certain diagnosis codes. The system assumes sicker…

ACO REACH Versus MSSP and the Cost of Risk

Health Policy and Economics

ACO REACH vs MSSP and the Cost of Risk

ACO REACH versus MSSP demands a strategic choice on risk, equity, governance, and capital. Here is what healthcare leaders need to assess in 2026….
Healthcare Private Equity Oversight Is Tightening

Assisted Living

Private Equity Oversight Is Tightening

Healthcare private equity oversight is changing deal risk, board governance, and accountability for providers, investors, and policymakers alike nationwide….
Managed Care Contracting Is Now a Margin Test

Health Policy and Economics

Managed Care Contracting Is a Margin Test

Managed care contracting now determines far more than a rate sheet. For post-acute and senior living leaders, it is a test of margin, access, and control….
Medicare Overpayment Demands Are a Strategic Risk

Health Policy and Economics

Medicare Overpayment Demands and Risk

Medicare overpayment demands can expose weak controls, strain cash flow, and invite scrutiny. Providers need a disciplined response before recoupment begins….
Medicare Advantage vs Traditional Medicare

Health Policy and Economics

Medicare Advantage vs Traditional Medicare

Medicare Advantage vs traditional Medicare is no longer a beneficiary-choice discussion alone. It is a market-structure issue affecting referral patterns, hospital utilization, post-acute length of stay, network access, risk-bearing arrangements, and the financial viability of…

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Reg

Healthcare executive, consultant, and author covering post-acute care, senior living, and the economics behind both - for 30+ years.

The Weekly Briffing

No noise - just what changed in healthcare policy and economics, and why it matters to your operation.