Healthcare, Senior Living, Economics
Medicare home health and hospice billing fraud has emerged as a significant issue within the U.S. healthcare system, costing taxpayers billions of dollars annually and jeopardizing the integrity of federal health programs. Fraudulent practices in this sector not only drain public resources but also compromise the quality of care provided to vulnerable populations, including the … Read more
According to a Feb. 11 report by Chartis, 432 rural hospitals are at risk of closure. Chartis analyzed 15 indicators and identified 10 significant predictors, including Medicaid expansion status, average length of stay, occupancy, changes in net patient revenue, and years of negative operating margin. The full report is available here: CCRH WP – 2025 … Read more
The Department of Justice (DOJ) announced that the agency recovered $2.9 billion in resolutions to federal False Claims Act allegations for 2024 (fiscal year ending September 30). This is a slight increase from the historic $2.7 billion recovered in fiscal year 2023. Office of Public Affairs | False Claims Act Settlements and Judgments Exceed $2.9B … Read more
Last week via a member news release from Leading Age Minnesota, the specter of federalized Assisted Living regulation popped up. Per this release, legislation enabling federal assisted living regulation of some form is anticipated to be proposed by U.S. Senator Mark Kelly (D-AZ) prior to the year’s end. The primary outcome of what Senator Kelly … Read more
Back in 2019, CMS issued revisions to Appendix Q of the State Operations Manual pertaining to Immediate Jeopardy considerations (on the part of surveyors) and ultimately, citation decisions. This guidance was relevant for all provider and supplier types participating in Medicare (hospitals, home health, SNFs, etc.). In late October, CMS issued guidance on penalties. What … Read more
It has been a busy week and next week is a holiday week (Thanksgiving) so of course, a shortened news and work week. That said, there is a lot going on right now and for followers and readers, I thought sharing my top four topics to watch made sense. Tort Reform: Back in February, the Georgia … Read more
Yesterday, CMS dropped a memo to state survey agencies titled, “Ensuring Consistency in the Hospice Survey Process to Identify Quality of Care Concerns and Potential Fraud Referrals”. The memo is available here: qso-25-06-hospice According to CMS, the memorandum aims to bolster current mechanisms for detecting instances where a hospice provider’s failure to adhere to the … Read more
This case caught my attention back in March as it raises issues that I commonly hear about namely, staffing agency costs and possible abuses in terms of actual time worked v. time billed by the agency. My March post is available here: https://rhislop3.com/2024/03/28/skilled-nursing-operator-takes-legal-action-against-staffing-platform-for-alleged-overbilling/ Nursa, an electronic staffing application company based in Utah, filed a lawsuit … Read more
On November 1 the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year 2025 Home Health Prospective Payment System (HH PPS) final rule, which updates Medicare payment policies and rates for Home Health Agencies. Unlike other Medicare provider types that have PPS rule updates corresponding to the federal fiscal year (10/1), home health … Read more
When the 2025 Final SNF PPS Rule was released, the focus was on Medicare rate increases. This is typically known as the “headline”. But as readers and followers here know, there is always a regulatory tidbit or two that can be even more significant in terms of operations, particularly as more and more Medicare patient … Read more