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
In a time of constantly changing markets, grasping economic indicators can give marketers a significant advantage. These indicators are statistical/data measures that provide a look into the economy’s present and future conditions, serving as potent instruments for devising marketing strategies in tune with consumer behavior, purchasing power, and the general state of the market. For … Read more
Here’s an oldie but a goodie for today. The House Ways and Means Committee is reportedly considering a markup of legislation this month that would revamp Medicare’s physician payment system. This move could increase the likelihood of incorporating a “doc fix” into a lame duck legislative package. Historic readers and followers of Reg’s Blog will … Read more
Tonight’s presidential debate should be policy focused but likely, won’t be or won’t be with sufficient detail. There are a ton of policy issues that should be discussed. Healthcare policy, in my opinion, should be very much a topic of open and frank discussion. I know I am a geek when it comes to economic … Read more
Late last year, CMS proposed a final rule to address the issue of coverage denials or service denials via prior authorization on behalf of Medicare Advantage Plans. Between providers and patients, coverage issues have significantly increased as beneficiary participation has increased (today, about 1 in 2 Medicare beneficiaries is in a Medicare Advantage plan). https://rhislop3.com/2023/11/09/cms-offers-fix-to-medicare-advantage-denials/ … Read more
Last week I wrote about Fitch Ratings updates to their non-profit CCRC rating criteria. The expectation with the changes was that twelve percent of the rated CCRCs could be subject to Under Criteria Observation (UCO). What has occurred as a result of Fitch Ratings Update is that eighteen CCRCs have been impacted, falling under UCO. … Read more
Fitch Ratings has completed updates to its ratings criteria for not-for-profit continuing care retirement/life plan communities (CCRCs), enhancing the reflection of the risk profile for these rated entities. These changes come after a period of commentary on a draft released earlier this spring. The criteria modifications aim to more accurately represent the distinct risks associated … Read more
According to a Wall Street Journal article from August 4, Medicare Advantage plans are using home nurse visits to identify possible or questionable disease states/conditions (so called, phantom diseases) via screenings. These diagnoses then turn into what appears to be, possible events of fraud via additional reimbursement tied to these new-found conditions. Exclusive | The … Read more
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
According to a recent JAMA (Journal of the American Medical Association) research letter private equity firms invested $505 billion in healthcare acquisitions from 2018 to 2023. These financial infusions can enhance resources for care. However, these firms have occasionally sold the land and buildings of acquired hospitals, using the proceeds to repay investors and leaving … Read more