Healthcare, Senior Living, Economics
Under the Final 2025 (PPS) rule released last Wednesday, nursing homes are set to receive a 4.2% pay increase in Medicare Part A. Additionally, the facilities will encounter a stricter fines system, with civil monetary penalties being applicable in more situations. The Final Rule is available here: SNF Final Rule 2025 In April I wrote … Read more
Developing a culture of transparency that promotes and sustains disclosure (speaking up) can yield advantages beyond merely decreasing misconduct. When employees feel empowered to speak up, they are more inclined to report issues related to safety, care, and to contribute service improvement suggestions, among other things. My firm, H2 Healthcare, has a robust compliance practice. … Read more
Now that it appears Kamala Harris will be the Democrat Presidential candidate, a look at her stance on various issues healthcare aka, her health policy, is timely. Important to note at his juncture, however, is that candidate Harris has not taken clear stakes on many current healthcare issues as Vice President, her roles were more … Read more
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
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
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
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
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
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
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. https://rhislop3.com/2024/04/15/monday-budget-day/ https://rhislop3.com/2024/04/16/medpac-report-to-congress-a-wrap-with-monday/ What follows is a different … Read more