Literature Review

Walgreens settles Illinois Medicaid fraud lawsuit for $5M Modern Healthcare; by Katherine Davis; 3/25/25 Walgreens Boots Alliance will pay $5 million to settle allegations that it violated U.S. and Illinois false claims statutes by improperly billing Medicaid and Medicare. The settlement, disclosed in court filings [3/24], marks the end of the dispute, which began 11 years ago when two whistleblowers claimed Walgreens’ practices violated statutes. ... The settlement, disclosed in court filings yesterday, marks the end of the dispute, which began 11 years ago when two whistleblowers claimed Walgreens’ practices violated statutes. ... The settlement funds will be divided among the U.S. government, the state of Illinois and the whistleblowers, according to court filings. All parties also filed a joint stipulation of dismissal yesterday. Walgreens declined to comment. [Continue reading; access to the full article may be limited to subscription ...]

[Palmetto] Home Health and Hospice Coalition Meeting Minutes: February 24, 2025Palmetto GBA press release; 3/27/25The February 24, 2025, Home Health and Hospice Coalition Meeting Minutes are now available. Please review this information and share it with your staff.

Five key CDC leaders abruptly retire amid agency shakeup: What to know Newsweek; by Gabe Whisnant; 3/25/25 The Centers for Disease Control and Prevention (CDC) is facing a major leadership shakeup, with five high-level officials stepping down in what marks the latest wave of internal turmoil for the nation's premier public health agency. According to the Associated Press, which confirmed the resignations through two CDC officials who requested anonymity because they were not authorized to speak publicly, the resignations were revealed during a senior leadership meeting on Tuesday. The announcement follows three other recent departures, and together, these changes amount to nearly a third of the CDC's top management either having already left or planning to do so. ... Why It Matters: The CDC, headquartered in Atlanta, operates more than two dozen centers and offices. The five latest officials to exit lead critical divisions, and while their departures have been described internally as retirements, they were not publicly announced.

MedPAC Report addresses hospital rate increases, new safety net funding, site-neutral payments Greater New York Hospital Association (GNYHA); Press Release; 3/24/25 In its March 2025 Report to the Congress, the Medicare Payment Advisory Commission (MedPAC) recommended increasing the 2026 hospital Medicare payment rate by the amount reflected in the current law (projected to be 2.5%) plus 1%, redistributing disproportionate share hospital (DSH) and uncompensated care (UC) payments to hospitals through a new Medicare Safety-Net Index (MSNI), and increasing the MSNI pool by $4 billion. ... The March 2025 report also included payment update recommendations for physicians and other health professional services, outpatient dialysis facilities, skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and hospice providers.  [Continue reading ...]

Lancaster woman convicted in hospice fraud schemeNBC-4 News, Los Angeles, CA; by City News Service; 3/21/25 A Lancaster [California] woman was found guilty Friday of receiving more than $330,000 in illegal kickbacks for patient referrals to two hospice companies in a fraud scheme that bilked Medicare out of more than $3.2 million through claims for medically unnecessary services. Callie Jean Black, 66, was convicted at the conclusion of a four-day bench trial in Los Angeles federal court of four counts of soliciting and receiving remunerations for patient referrals, according to the U.S. Attorney's Office. U.S. District Judge André Birotte Jr. scheduled sentencing for July 25. [Continue reading ...] 

RFK Jr. continues pioid Crisis PHE into its eighth year Inside Health Policy; by Dorothy Mills-Gregg; 3/19/25 HHS Secretary Robert F. Kennedy Jr. recently renewed the department’s longest ongoing public health emergency (PHE) first declared under the first Trump administration: the opioid abuse crisis. While the Centers for Disease Control and Prevention found a 25.5% decrease in overdose deaths in 2024 compared to the previous year, HHS says the opioid PHE needs to be renewed for another 90 days so federal coordination efforts can continue and key flexibilities for HHS will be preserved.Editor's note: How recently have you reviewed your Policies & Procedures for destroying drugs in the patient's home, upon death--in accordance with state laws? For staff education and accountability? For communicating this with family? For assessing possible drug diversion of opioids, with appropriate follow-up actions? Additionally, numerous hospice bereavement programs have been flooded with grief needs of bereaved family members from opioid deaths. Click here for the U.S. Department of Justice's Drug Enforcement Administration - Diversion Control Divsion; more focused, scroll down to their "Home Disposal Methods."

MedPAC recommends Congress tie physician pay to inflation for 2026 Healthcare Dive; by Susanna Vogel; 3/17/25 Dive Brief:

Medicaid’s role in health and in the health care landscape: LDI expert insights and key takeaways from select publications Penn LDI - Leonard Davis Institute of Health Economics, Philadelphia, PA; by Julia Hinckley, JD; 3/17/25... Medicaid accounts for one-fifth of U.S. health care spending and covers more than a quarter of Americans. LDI researchers have examined the services it provides in supporting aging adults, people with disabilities, and children, as well as its role in health crises such as chronic disease and suicide. ... Below are select key findings from recent peer-reviewed research, along with expert insights for policymakers considering changes to Medicaid funding in the federal budget.

Hospice industry gets reprieve as Trump admin pauses oversight program Axios; by Maya Goldman; 3/13/25 A federal effort to increase oversight of hospice care has been put on hold by the Trump administration, resetting efforts to root out fraud and abuse in an industry that receives more than $25 billion from Medicare annually. Why it matters: Federal officials in recent years have ramped up efforts to identify instances in which hospice operators fraudulently bill the government or enroll patients who aren't terminally ill. But the new administration last month halted a Biden-era plan for noncompliant hospices to take corrective action or risk being kicked out of Medicare. The big picture: Medicare is required by law to implement some version of the targeted oversight program. But it's not clear how that will evolve in President Trump's second term. 

13th Annual Healthcare Fraud & Abuse Review - 2024 JD Supra; by Bass, Berry & Sims PLC; 3/7/25 Bass, Berry & Sims is pleased to announce the release of the 13th annual Healthcare Fraud & Abuse Review examining important healthcare fraud developments in 2024. Compiled by the firm's Healthcare Fraud & Abuse Task Force, the Review provides a comprehensive analysis of enforcement developments affecting the healthcare industry, significant court decisions involving the False Claims Act, and an overview of settlements involving healthcare fraud and abuse issues.We began the Review over a decade ago with the intention of providing comprehensive coverage of the most significant civil and criminal enforcement issues facing healthcare providers each year. Over that time, the challenges facing the healthcare industry have been significant. ...

DOJ launches probe into UnitedHealth’s Medicare billing practices after investigative reports MSN; by Taylor Herzlich; 3/22/25 The Department of Justice has reportedly launched an investigation into UnitedHealth Group’s Medicare billing practices as scrutiny over the health insurance industry intensifies — sending the company’s stock plummeting.The probe is analyzing the company’s practice of frequently logging diagnoses that trigger larger payments to its Medicare Advantage plans, according to The Wall Street Journal. UnitedHealth shares plunged nearly 9% Friday. A series of Wall Street Journal reports last year found that Medicare paid UnitedHealth billions of dollars for questionable diagnoses.

Hospices traverse the ‘new twists’ in increasingly complex auditing processes Hospice News; by Holly Vossel; 2/20/25 Auditors are raising new questions around two common issues in hospices’ Medicare claims — documentation supporting patient eligibility and the physician narrative. Program integrity issues and quality concerns have raised the bar of regulatory oversight in recent years, with auditing activity ramping up as more providers undergo multiple audits simultaneously each year. ... Claim denials most frequently occur due to insufficiently documented evidence that demonstrates a patient’s eligibility within the physician narrative explanation, Nowicki stated. Auditors have increasingly required more details to support a patient’s six month terminal illness prognosis, potentially stretching the boundaries of hospice requirements stipulated by the U.S. Centers for Medicare & Medicaid Services (CMS), he indicated. [Click on the title's link to continue reading.]

5,200 job cuts at HHS: What to know Becker's Hospital Review; by Madeline Ashley; 2/14/25 The Trump administration on Feb. 13 ordered HHS to lay off "nearly all" of its 5,200 probationary employees, The Associated Press reported Feb. 14. In a National Institutes of Health department meeting recording obtained by the AP, an NIH office director said some probationary employees with specialized skills might be retained. Affected employees were notified via email on the afternoon of Feb. 13. Many probationary employees are people who have worked for the federal government for about one to two years, before gaining civil service protections. Some probationary employees are veteran staffers who may have been recently promoted, according to the AP.