Literature Review

HHS proposal slashes Medicare SHIP funds MSN; by Mary Helen Gillespie; 4/22/25 The Trump administration is proposing federal budget cuts to Medicare State Health Insurance Assistance Programs (SHIP) and seven additional elder health care safety net programs that assist older Americans. ... SHIP programs have been under the umbrella of the Health and Human Services agency Administration for Community Living. The pre-decisional budget lists funds for seven other ACL programs that would be eliminated are:

Jury convicts home health agency executive of fixing wages and fraudulently concealing criminal investigation U.S. Department of Justice - Office of Public Affairs; Press Release; 4/14/25 A federal jury convicted a Nevada man today for participating in a three-year conspiracy to fix the wages for home healthcare nurses in Las Vegas and for fraudulently failing to disclose the criminal antitrust investigation during the sale of his home healthcare staffing company.  According to court documents and evidence presented at trial, Eduardo “Eddie” Lopez of Las Vegas, Nevada conspired to artificially cap the wages of home healthcare nurses in the Las Vegas area between March 2016 and May 2019. The three-year conspiracy affected the wages of hundreds of Las Vegas registered nurses and licensed practical nurses who provide care to patients in their homes. During the pendency of the government’s investigation, Lopez then sold his home healthcare staffing company for over $10 million while fraudulently concealing the government’s criminal investigation from the buyer.  

HHS cuts pose threat to older Americans' health and safety Newsweek; by Kristin Lees Haggerty and Scott Bane - The National Collaboratory to Address Elder Mistreatment at Education Development Center (EDC); The John A. Hartford Foundation; 4/17/2 On March 27, 2025, the federal government announced major cuts to the department of Health and Human Services (HHS). ... Sounding the Alarm for Elder Justice: The population of older adults is rapidly growing, and one in 10 experience abuse, neglect, and/or exploitation—a risk that is even higher for those living with dementia. ... Cutting services to older adults will increase these risks and costs. Moreover, ... 11.5 million family and friend caregivers provide over 80 percent of help needed for people living with dementia in the U.S. Without access to services like Meal on Wheels, adult day care, and respite care, we can expect caregiver burden and strain to increase significantly and with it, rates of elder abuse, emergency department visits, hospitalizations, and nursing home placements. We know this because of the abuse spike seen clearly during the COVID-19 pandemic, which doubled to over 20 percent of older adults, as services were limited, and older adults were socially isolated. HHS cuts are also likely to result in loss of specialized expertise in identifying and addressing elder mistreatment, so that when elder abuse does occur, we won't have the services to stop it and make sure it won't happen again.

CMS clarifies physician referral authority, tightens attestation requirements in proposed hospice ruleInside Health Policy; by Jalen Brown; 4/11/25... The proposed rule would explicitly allow the physician member of the hospice interdisciplinary group (IDG) to recommend patients for hospice care, addressing a gap in current regulations over which physicians have that authority. While CMS already lets IDG physicians certify that a patient is terminally ill and eligible for hospice, the existing admission rules only name the hospice medical director or physician designee as authorized to recommend admission. CMS also wants to strengthen documentation requirements for hospice recertification, ... Starting at day 180 and every 60 days thereafter, Medicare requires a hospice physician or nurse practitioner (NP) to conduct a face-to-face visit with the patient before recertifying eligibility. After the visit, the clinician must provide a written attestation confirming that the visit occurred and was used to assess whether the patient still qualifies for hospice care. Under CMS' proposal, that attestation would also need to include the clinician's signature and the date signed, submitted as a clearly labeled section or addendum to the recertification form. 

How ACOs think CMS should change the rules for value-based careModern Healthcare; by Bridget Early; 4/11/25Providers participating in accountable care organizations and other value-based payment arrangements with Medicare have a wish list for the new team running the Centers for Medicare and Medicaid Services... These are three top priorities for value-based care program participants in 2025:

CMS Refocuses on its Core Mission and Preserving the State-Federal Medicaid PartnershipCMS press release; 4/11/25The Centers for Medicare & Medicaid Services (CMS) is taking action to preserve the core mission of the Medicaid program by putting an end to spending that duplicates resources available through other federal and state programs or isn’t directly tied to healthcare services. Mounting expenditures, such as covering housekeeping for individuals who are not eligible for Medicaid or high-speed internet for rural healthcare providers, distracts from the core mission of Medicaid, and in some instances, serves as an overly-creative financing mechanism to skirt state budget responsibilities.

2026 Medicare Advantage and Part D rate announcementCMS press release; 4/7/25Today, the Centers for Medicare & Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2026 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the CY 2026 Rate Announcement)... The final policies in the CY 2026 Rate Announcement are projected to result in an increase of 5.06%, or over $25 billion, in MA payments to plans in CY 2026.

AGG talks: Home health & hospice podcast - Episode 10: Anti-Kickback Compliance for hospice and skilled nursing providers JD Supra; by Arnall Golden Gregory, LLP; 4/3/25 In this episode, AGG Healthcare attorneys Bill Dombi and Jason Bring discuss recent OIG guidance on hospice and skilled nursing facility relationships, focusing on anti-kickback risks and fraud concerns. They cover key issues such as the importance of documenting fair market value for any services or space provided, being cautious of payments exceeding Medicaid room and board rates, and avoiding arrangements that appear to be made solely to secure referrals. Bill and Jason also touch on increased oversight and enforcement in the healthcare sector under a new presidential administration.

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 ...]