Medicare Fraud and Why; Part II

Last week I published a post regarding Medicare fraud that is occurring in the post-acute industry.  The post is available at http://wp.me/ptUlY-ak .  At the end, I indicated that I would provide a follow-up post; a closer piece more succinct on why the fraud trend is heating up and what the drivers for this trend are.  In … Read more

Medicare, Fraud and Why: Perspectives on the Post-Acute Industry

What never ceases to amaze me is the amount of post-news discussion that occurs when certain issues rise to the front-page (or near the front page).  Seemingly, industry side-liners awaken and look in disbelief that one major provider organization or another is again, embroiled in some OIG investigation, lawsuit or official inquiry concerning their Medicare … Read more

Current Policy Trends to Watch

In response to a recent series of questions from multiple segments of the health care and post-acute industry plus my own experiences within the landscape of providers and policy makers, I’ve summarized a current list of policy trends “pay attention to”. Medicare Cuts and the Super Committee: Nothing seems to loom larger or cast a … Read more

Post-Payment Reductions: Build a Revenue Model for Success

Not too long ago I wrote a post for SNFs regarding “what to do” in preparation for October 1 rate reductions.  Since then, I’ve fielded inquiries galore from all kinds of providers looking into a future that likely includes Medicare and certainly, Medicaid rate/payment reductions.  In most cases, the answer that I provide is clearly … Read more

Post-Acute Outlook Post Debt Ceiling, Post Medicare Rate Adjustments, Etc.

OK, the title is a bit wordy and trust me, I could have included more “posts” but I think I got the point across.  First, I’ll admit to having a crystal ball however, the picture I see is a bit like the first (and only) television set I remember having as a kid: Not in … Read more

OIG on Hospice: Restructure Hospice Payments for SNF Residents

This past week, the OIG released a report that represents a more definitive study of hospice payments and utilization trends under Medicare.  The report is effectively a follow-up to recommendations made in MedPac’s annual report(s) to Congress.  The report provides a review of OIG’s analysis of the growth of Medicare covered hospice patients over the … Read more

The Unraveling of the PPACA

OK readers and requesters, I haven’t gone, as Robert Frost wrote, into the “woods lovely, dark and deep” but I have been preoccupied by work and things familial.  Sadly, energy wanes as one focuses intently on the delicate balance that is juggling a frenetic work schedule, a mile of other professional commitments, travel, and family.  … Read more

House Passes Jobs Bill Containing Enhanced FMAP

On a party line vote, the House of Representatives passed legislation euphemistically coined the “jobs bill”.  The $26 billion dollar legislation includes a $10 billion appropriation for state school budgets and $16 billion to continued the enhanced FMAP (Medicaid match) provided under the ARRA (Stimulus bill), set to expire on December 31.  The vote was … Read more

Enhanced FMAP Funding Moving Through the Senate

On December 31st of this year, enhancements made to the Medicaid FMAP (Federal matching dollars) via the ARRA (Stimulus or American Recovery and Reinvestment Act) are set to evaporate.  In a series of bills and other legislative initiatives throughout the spring and early summer, Congress has failed to extend funding to prevent the evaporation of … Read more

Compliance, the Courts and a Risk Reminder

In previous posts I’ve written about the need for providers in all industry sectors to fully understand the compliance and legal risks that are inherent to the appropriate industry sector, as well as to health care today in general.  As someone who has been immersed in health care operations and health policy for the past … Read more