Update: Medicare Advantage Prior Authorization
A review of Medicare Advantage prior authorization, what federal oversight has changed, and why operators still face administrative and revenue risk now.
Nursing Homes
Fee for Service vs Value Based Care
Fee for service vs value based care changes who carries risk, how providers are paid, and what senior care leaders must build for the next cycle of care.
CMS Changes SNF Surveys With New Risk Surveys
CMS modernizes nursing home oversight with new risk-based survey approach, shifting federal scrutiny toward facilities where resident harm is most likely.
Medicare Reform Analysis Update
The real Medicare reimbursement reform analysis starts with a hard truth: this is no longer a debate about payment mechanics. It is a debate about who absorbs risk, which care settings remain financially viable, and whether federal policy can restrain spending without destabilizing access. For operators in post-acute care, senior living, home health, hospice, and … Read more
Agency Scrutiny of PE in Healthcare
My last post covered the legislative activity (Congress) concerning private equity’s role and investment in healthcare, particularly physician practices and hospitals https://rhislop3.com/legislation-restricting-pe-role-in-healthcare/ . Aside from legislation, a myriad of federal agencies are equally engaged. Federal Inquiry into Private Equity Control in Health Care In 2024, the Federal Trade Commission (FTC), the Department of Justice’s Antitrust … Read more
Private Equity Ownership Scrutiny
Private equity investment and ownership in healthcare businesses has been a frequent topic in the news, with coverage largely focusing on negative aspects of private equity’s involvement and engagement in this sector. Recent Legal and Regulatory Developments One notable case highlighting concerns about private equity’s role in healthcare occurred in Sacramento County. A jury awarded … Read more
VOHRA Wound Care Faces Medicare Fraud Claim
The U.S. Department of Justice (DOJ) filed a False Claims Act lawsuit on April 4, 2025, against Vohra Wound Physicians Management LLC, Dr. Ameet Vohra, and VHS Holdings, P.A., in the U.S. District Court for the Southern District of Florida (Case No. 25-cv-21570). The complaint alleges that since December 2017, Vohra engaged in a nationwide … Read more
Medicaid Spending in the DOGE Radar
Introduction Mr. Musk’s DOGE team has requested access to CMS systems, which manage over $1 trillion in annual payments, according to documents obtained by the New York Times. This initiative, led by Mr. Musk’s longtime associate Steve Davis, aligns with a broader effort to reduce federal spending by scrutinizing payments and contracts. Hospital and health … Read more
Senior Living Capital Outlook 2025
Since the pandemic (COVID), capital investment in senior living has been disjointed (to say the least). The pandemic constrained demand and as the economy rebounded from periods of lockdowns, supply shortages, work reductions, etc., inflation snuck in. In turn, to battle inflation, the Federal Reserve steadily raised interest rates. The rise in rates changed the … Read more
CMS Issues Updates on Immediate Jeopardy
Back in 2019, CMS issued revisions to Appendix Q of the State Operations Manual pertaining to Immediate Jeopardy considerations (on the part of surveyors) and ultimately, citation decisions. This guidance was relevant for all provider and supplier types participating in Medicare (hospitals, home health, SNFs, etc.). In late October, CMS issued guidance on penalties. What … Read more