Healthcare, Senior Living, Economics
Medicare home health and hospice billing fraud has emerged as a significant issue within the U.S. healthcare system, costing taxpayers billions of dollars annually and jeopardizing the integrity of federal health programs. Fraudulent practices in this sector not only drain public resources but also compromise the quality of care provided to vulnerable populations, including the … Read more
Introduction House Republicans released a budget blueprint on February 12th that directs the Energy and Commerce Committee to achieve $880 billion in savings from fiscal years 2025 through 2034. GOP Budget Reconciliation Bill Draft Budget Overview The budget resolution does not provide specific instructions on how the committee should achieve the $880 billion in savings. … Read more
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
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
On Monday, January 20, Donald Trump will be inaugurated as the 47th president of the U.S. While his claim of an election mandate is very debatable, the expectations that come with his return to office are many. Chief among these expectations is that he/his administration will “fix” the debt driven, inflation riddled economy of the … Read more
Last week via a member news release from Leading Age Minnesota, the specter of federalized Assisted Living regulation popped up. Per this release, legislation enabling federal assisted living regulation of some form is anticipated to be proposed by U.S. Senator Mark Kelly (D-AZ) prior to the year’s end. The primary outcome of what Senator Kelly … Read more
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
It has been a busy week and next week is a holiday week (Thanksgiving) so of course, a shortened news and work week. That said, there is a lot going on right now and for followers and readers, I thought sharing my top four topics to watch made sense. Tort Reform: Back in February, the Georgia … Read more
As anticipated, litigation has started via various sources, in Federal courts, challenging CMS’ SNF “staffing mandate”. For specifics on the mandate and actual text, go here: https://rhislop3.com/2024/04/23/cms-final-snf-staffing-rule/ A big impetus behind the legal challenges to CMS mandate is the recent Supreme Court ruling known as the Chevron decision https://rhislop3.com/2024/07/01/scotus-chevron-decision-a-win-for-healthcare/ The decision overturns a longstanding doctrine … Read more
On September 30, US District Judge Kathryn Kimball Mizelle from the Middle District of Florida ruled in a landmark decision that the qui tam provision of the federal False Claims Act (FCA) is unconstitutional. This ruling could have significant impact on whistleblower (Qui Tam) actions filed against healthcare providers, particularly home health and hospice (most … Read more