Healthcare, Senior Living, Economics
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
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
On September 30, US District Judge Kathryn Kimball Mizelle from the Middle District of Florida ruled in a landmark decision that the qui tam provision of the federal False Claims Act (FCA) is unconstitutional. This ruling could have significant impact on whistleblower (Qui Tam) actions filed against healthcare providers, particularly home health and hospice (most … Read more
The Accreditation Commission for Health Care, Inc. (ACHC) has launched two new specialty credentials for organizations providing home care and/or hospice. These programs are in line with the Age-Friendly Health Systems (Care) programs and initiatives started by The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI), in partnership with the American Hospital Association (AHA) and … Read more
Since I started this site, a topical area that has been a constant for me is hospice and in particular, fraud and abuse. Recent cases have again put Hospice fraud and abuse, front and center. Thematically, the cases are different and the same in so much that they involve improper billing of hospice cases to … Read more
Private equity investment in the nursing home and assisted living sector (other post-acute as well) continues to be a focus of regulatory activity in Congress. This is despite private equity investment in the nursing home sector to be involve about 5% of facilities. Home health has seen an increasing investment interest as well from private … Read more
As inflation has cooled, senior living rate increases are slowing. Growing occupancy has been a function of incentives, particularly rate concessions and discounts. The greatest use of discounting is in independent living, particularly Life Plan organizations/CCRCs. And, while rate increases shift lower, revenue does as well. Unfortunately, operating cost increases are not subsiding, especially with … Read more
Somewhat buried within the Home Health Final Rule (PPS) was an update on a CMS initiative to identify hospice agencies requiring additional regulatory oversight for poor care performance (poor quality, unsafe care practices). Back in 2021, CMS began the Special Focus initiative and in the 2024 Hospice Final Rule, CMS indicated that the recommendations for … Read more
A complex area for providers, especially with respect to their compliance programs, are the concepts of fraud and abuse. Central to current requirements for compliance programs, all post-acute providers are REQUIRED to have compliance programs that, Include policies and procedures to define, test for, and mitigate any issues pertaining to fraud and abuse. In this … Read more
While mergers and acquisitions are generally down, affiliations, closings in some cases, and sponsorship changes in non-profit senior living and care are at a record pace. Back in July, I wrote about the disconnect between acquisitions and the merger/affiliation changes occurring among non-profits. That post is here: https://rhislop3.com/2023/07/24/senior-living-and-care-ma-two-worlds/ A news release from Ziegler Investment Banking, … Read more