Medicare Fraud: $2.75 Billion Recovered

Late June, the Department of Justice released its 2024 Healthcare Fraud Enforcement Action, detailing actions against nearly two hundred individuals, encompassing Medicare fraud totaling $2.75 billion in recovered losses ($1.6 billion in actual cash losses). One of the major problems with Medicare, aside from its structural financing, is that it is bureaucratically bloated, full of … Read more

SCOTUS Chevron Decision a Win for Healthcare

Last week, the Supreme Court discarded a longstanding doctrine that granted regulatory agencies, such as the Centers for Medicare & Medicaid Services, extensive leeway to establish regulations for the organizations under their jurisdiction. The decision (majority opinion) in the case of Loper Bright Enterprises v. Raimondo¬†is available here: SCOTUS Chevron Ruling The decision overturns a … Read more

Altarum Report: Healthcare Spending Accelerates Between May 23 and May 24

From May 2023 to May 2024, the overall healthcare costs accelerated (increased) by 3.4%, marking the most rapid increase since December 2007, as reported in Altarum’s monthly Health Sector Economic Indicators brief, released yesterday. The report is available here: Altarum-June-2024-HSEI-Combined Expenditures on nursing home care increased by 4.8% year-over-year, while home healthcare spending saw a … Read more

Hospice Fraud and Abuse Front and Center

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

DOJ Gets Aggressive in Pursuit of Telehealth Fraud

It was only a matter of time before cases involving telehealth fraud/False Claims Act cases became public.¬† This week, two press releases from the DOJ illustrated how aggressive the agency has become in the pursuit of telehealth related fraud. I suspect more, larger in implication (dollar value, geographic spread), will drop publicly in the next … Read more

Regulation Monday: SNF Staffing Mandate and Medicaid Access Rule

Just announced this morning, CMS has finalized two hotly debated proposed rules into final rules. The final rules involve the SNF staffing mandate proposed last year and the Medicaid Access Rule, requiring 80% of payments for Medicaid HCBS programs go to compensation for direct care workers. The Medicaid Rule follows the original proposed rule while … Read more

Wednesday Feature: Budget Stuff…Cubed

Happy Hump Day! Busy day so far but wanted to sneak this post in, wrapping up the last two days of posts on budget (federal, Medicare) stuff. This being the third day and post on budgets (and last for a while, I promise), the title fits – cubed. What follows is a different … Read more

MedPAC Report to Congress: A Wrap with Monday?

Yesterday I wrote a post on President Biden’s healthcare budget. Today, I thought a quick visit back to March and MedPAC’s Annual Report to Congress on payment and program adequacy would be a good “wrapper” – for now. Every year, MedPAC (the Medicare Payment Advisory Commission) reports to the Congress in March on the Medicare … Read more

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?” 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