15 Days to Slow the Spread: Remembered

On March 16, 2020, the Trump Administration released guidelines in response to the COVID-19 outbreak and the corresponding public health emergency. Four years later, much was learned, much was missed, much could have played-out different, and much remains to be reconciled. Today, four years later, we live with economic and societal ramifications from the public … Read more

Legislation Grab Bag

Within the normal news cycle, legislation often gets ignored, especially in this hyper volatile election cycle we have begun. I’m expecting very little in terms of reform or new legislation on important healthcare issues to come forward, and, so far, I’m right. With near gridlock due to small opposing majorities in both houses of Congress, … Read more

Penn and Teller and the Disappearing SNF

When I got married to my wife and business partner (the partner came after), part of our honeymoon was spent in Las Vegas. While there, we caught Penn and Teller’s Vegas show and it was AWESOME! I love magic and in particular, the kind that is up close and personal. The trade term now seems … Read more

Record-breaking $2.7 Billion Paid by Healthcare Providers in False Claims Act Cases

A couple of weeks ago, on February 22nd. the Department of Justice issued its annual statement regarding False Claims Act activity in FY 2023 (federal fiscal years run 10/1 to 9/30). “Settlements and judgments under the False Claims Act exceeded $2.68 billion in the fiscal year ending Sept. 30, 2023. The government and whistleblowers were … Read more

Friday Feature: Legal Battle Unfolds Over Nursing Home Negligence Amid Pandemic Era

TGIF! Within a busy econ news week, a little litigation matter slipped into my news stream. These cases are fascinating as we continue to see the pandemic litigation trickle forward and the novelty of claims arising from the pandemic period/Public Health Emergency period beginning to define the litigation playing field. Readers/followers know by now that … Read more

Unlocking the Potential: Overcoming Challenges for LTPAC Providers in ACO Participation

Yesterday, the American Health Care Association and the National Center for Assisted Living plus the National Assocation of ACOs released a white paper that includes a set of recommendations for CMS, designed to increase the participation of long term and post-acute care (LTPAC) providers in accountable care organizations (ACOs).  The white paper is available here: AHCA … Read more

Wednesday Feature: Navigating the Evolving Landscape – Enhancing Ethics and Compliance Programs for Risk Mitigation

Happy Hump Day! Long title for what is going to be, a rather brief post.  As followers and regular readers know, my firm (I am the co-founder and part owner) H2 Healthcare, LLC has a practice area uniquely concentrated on clinical compliance and complex litigation support.  The practice area is headed by Diane Hislop, RN (yes, … Read more

The Financial Struggle of Rural Hospitals: A Growing Concern for Healthcare Access

Among the many healthcare sectors I follow, rural healthcare has become my favorite. Oddly enough, it’s not because of the policy issues that exist, though it should be. It is because it is an overlooked sector and one that has a real risk of collapse. Last summer (2023) I wrote a post about the plight … Read more

Friday Feature: Litigation, Arbitration, and COVID

TGIF! I live and have an office in Illinois, though my part of the state differs dramatically from the Illinois most people recognize. I live and work in a small town (Galena) in an area known as the driftless region. The driftless region is “original” terra-firma, where the glaciers did not touch. This area is in the far northwest … Read more

Rising Tide of Audits: Brace Yourself for Increased Scrutiny on Skilled Nursing Providers in 2024

In 2023, regulators re-instituted audits of facilities for inappropriate diagnoses of schizophrenia (justification for anti-psychotic use), plus a five-claim audit of every nursing home. The purpose of the audit was to address a long-standing concern that inappropriate coding was driving higher Medicare reimbursement under PDPM, despite documentation in patient records, not substantiating the level of care … Read more