Healthcare, Senior Living, Economics
Today’s post is a bit of a hybrid. I’m trying to keep up with a bunch of things ranging from policy to economics (Jerome Powell speech today) to some work stuff so I’m combining two things today that probably, deserve a bit more dissection, but this will do for now. Plus, I’m hopeful that tomorrow … Read more
Back in early June, I wrote a post on how Medicare/CMS was intending to audit 5 claims from every participating SNF in the country. The audits would be staggered and conducted by MACs (Medicare Audit Contractors). That post is available here: https://wp.me/ptUlY-AR As we are now three months into the audit process, details are emerging … Read more
Usually I try to add some “light and levity” to my Wednesday features as the content on this site is pretty heavy health policy and economics, regulatory in nature, etc. In my work, my usual Wednesday messages internally are “fun” – a bit of Hump Day humor or whimsy. By title of this post, readers … Read more
Yesterday, I wrote a post regarding health systems and providers looking at finding efficiencies and, in some cases, cutting staff – particularly at the administrative and executive levels. Providers are being tasked with making do with less as the economic headwinds remain stiff, even gale force in some cases. Part of the challenge for providers … Read more
As I close the week, I’ve been following a lot of legal news, specifically court cases involving health care and in one case, a decision from the Supreme Court. Legal news can be rather arcane and boring but, in some cases, the implications of decisions can be rather profound. Such is the case (no pun … Read more
In a series of news stories starting with a piece in the New Yorker published last November, hospices, particularly for-profit hospices in certain states, are being called-out for fraudulent activity. The New Yorker article headline begins, “It began as a visionary notion—that patients could die with dignity at home. Now it’s a twenty-two-billion-dollar industry plagued … Read more
Recently, CMS announced that its Medicare Audit Contractors (MACS) would soon commence (June 5) a five-claim audit process for every nursing home in the nation participating in the Medicare program. The reviews are set to occur on a rolling basis whereby each MAC in its region, will begin by pulling five Medicare claims from each … Read more
Despite significant delays due to COVID, Phase 3 requirements of the “mega rule” are now in effect and one of the most unique elements for SNFs is the Ethics and Compliance requirement – 483.25. A good primer on the requirement is attached here. I have highlighted some key points relative to this post. SNF Compliance … Read more
Over my career, I have done a fair amount of M&A work….CCRCs, SNFs, HHAs, Physician practices, hospice, etc. While each “deal” has lots of nuances, issues, etc. none can be as confusing or as tricky to navigate as the federal payer issues; specifically, the provider number. For SNFs, HHAs, and hospices, an acquisition not properly … Read more
Nearing the end of the Supreme Court session, the Court issued an important clarification ruling concerning the False Claims Act in cases of alleged fraud. In the Universal Health Services case, the Court addressed the issue of whether a claim could be determined as fraudulent if the underlying cause for fraud was a lack of professional certification … Read more