Healthcare, Senior Living, Economics
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
Not too long ago, I wrote a post regarding federal legislative activity seeking to impose regulation on Private Equity firms investing in senior living organizations (SNFs, home health, hospice, assisted living). That post is available here: https://rhislop3.com/2024/06/13/private-equity-investment-in-nursing-home-sector-generates-regulatory-scrutiny/ That post focused on a bill known as the Corporate Crimes Against Health Care Act of 2024 aims … Read more
As of the latest demographic data from Pew Research, 62 million people in the U.S. are age 65 or older Number of people 100 and older is growing in US and around the world | Pew Research Center Presently, there are approximately 7,500 licensed geriatricians in the U.S., or 1 per every 8,267 seniors. Despite … 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
Recently (June 12), the Federal Reserve held its latest FOMC (Federal Open Markets Committee) meeting and decided to maintain the current Fed Funds rate within the range of 5.25% to 5.50%. The reasoning remains the current position of the economy, inflation therein, signals that inflation is a bit more persistent, and that without more definitive … 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