Monday = Budget Day

As much as politics consumes the news, little on policy is included. Most days, the political stuff such as trials, Congressional hearings, back and forth tabloid (almost) stuff is front and center, missing is the “meat”. Reminds me of the 80’s Wendy’s commercial titled, “Where’s the beef?” https://www.youtube.com/watch?v=riH5EsGcmTw While I know that the national election, … Read more

Friday Feature: An End to Arbitration Clauses?

TGIF! It’s been a long week with the eclipse and lots of economic news plus all the stuff going on in the Middle East. My inbox is flooded so weekend reading will need to include a lot of parsing and pitching. On Tuesday in the Senate, a bill was introduced by Senators Blumenthal (CT) and … Read more

The Politics of Population and Immigration

Followers know that I don’t write much about politics, staying pretty straight-forward on health policy and economics topics. A little diversion occurs today, but honestly, not much. We are after all, in an election cycle and thematically (the title), demographics will be center stage but likely, for the wrong reasons. As I watch the election … 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

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

Friday Feature: Healthcare Economics Update

TGIF! A report I get and enjoy comes from Altarum (a non-profit consulting organization) looking at various economic data elements with regard to healthcare spending across a number of metrics (percent of GDP, time series growth, etc.). Granted, the report is a bit “wonky” but given what I do for a living, “wonky” is kind … Read more

Wednesday Feature: Neglected, Uninspected – Senate Aging Committee Report on SNF Surveys

Happy Hump Day! Yesterday I wrote about the OIG’s (Department of Health and Human Services) report and focus on CMS’ oversight of state survey agencies. The impetus behind this focus no doubt comes from the U.S. Senate Special Committee on Aging’s investigation into nursing home survey activities at the state level. The report is available … Read more

OIG: CMS Should Take Action Against States with Poor SNF Survey Performance

Last week, the U.S. Department of Health and Human Services Office of the Inspector General (OIG), issued a report regarding the performance of contracted state agencies with respect to nursing home (SNF) compliance surveys. CMS contracts with state agencies, typically state departments of health or divisions thereto, to perform compliance/regulatory activities (surveys) in nursing homes. The report … Read more