Literature Review

Trump administration to shut down CMS, HHS minority health offices amid restructuring Healthcare Dive; by Rebecca Pifer; 3/31/25 The CMS and HHS offices that coordinate efforts to eliminate health disparities are being shut down completely as part of the Trump administration’s overhaul of the federal healthcare department, according to sources with direct knowledge of the matter. Closing the offices will impact efforts to improve the health of underserved patients in the U.S. — and is probably illegal, according to experts. ... Shutting the offices, which were authorized by the Affordable Care Act more than a decade ago, may also be illegal, according to legal experts. [Continue reading ...]

HHS restructures duals, PACE offices amid department overhaul Modern Healthcare; by Bridget Early; 4/3/25 The Health and Human Services Department is reorganizing a handful of key programs for dually eligible enrollees and older adults, including laying off numerous staffers. HHS is shuffling how it manages care coordination for people dually eligible for Medicare and Medicaid under the Medicare-Medicaid Coordination Office and the Program of All-Inclusive Care for the Elderly. PACE, which had been poised for growth, offers home and center-based care mostly to dual-eligible Medicare and Medicaid enrollees who qualify for skilled nursing but can still live in their communities. A spokesperson for HHS said the department has “planned productivity enhancements for the PACE management department.” HHS did not elaborate on what management changes for the PACE program might look like.

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 ...]

Medicare Administrative Contractors [MACs] did not consistently meet Medicare Cost Report Oversight Requirements HHS-OIG; Issued on 3/18/25, posted on 3/19/25 ... What OIG Found: MACs did not consistently meet Medicare cost report oversight requirements.

Evaluation of the Medicare Advantage Value-Based Insurance Design model test: 2020 to 2023  RAND Health Care, prepared for the Centers for Medicare & Medicaid Services Center for Medicare and Medicaid Innovation Under Research, Measurement, Assessment, Design, and Analysis Contract Number 75FCMC19D0093, Order Number 75FCMC20F0001; by Christine Eibner, Dmitry Khodyakov, Erin A. Taylor, Denis Agniel, Rebecca Anhang Price, Julia Bandini, Marika Booth, Lane F. Burgette, Christine Buttorff, Catherine C. Cohen, Stephanie Dellva, Michael Dworsky, Natalie C. Ernecoff, Alice Y. Kim, Julie Lai, Monique Martineau, Nabeel Qureshi, Afshin Rastegar, Max Rubinstein, Daniel Schwam, Joan M. Teno, Anagha Tolpadi, Shiyuan Zhang; March 2025 This report presents RAND researchers’ findings from their evaluation of the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model test for 2020 through 2023, initiated by the Center for Medicare and Medicaid Innovation (Innovation Center). The VBID Model allows participating MA parent organizations (POs) to offer supplemental benefits, financial and nonfinancial incentives to beneficiaries, hospice benefits (the Medicare Hospice Benefit, Palliative Care, Transitional Concurrent Care, and Hospice Supplemental Benefits), and Wellness and Health Care Planning through their MA plans.

AGG, New Day’s Bill Dombi: Hospices’ ‘vibrant evolutionary path’ spurs legal growing pains  Hospice News; by Holly Vossel; 3/26/25 Today’s hospice landscape is reaching a pivotal point of evolutionary growth that has come with increased oversight as regulators seek to curb fraudulent activity in the space, according to Bill Dombi, senior counsel for the law firm Arnall Golden Gregory (AGG). ... He previously served as president of the National Association for Home Care & Hospice (NAHC) for 38 years prior to its affiliation with the National Hospice and Palliative Care Organization (NHPCO) in 2023 and was heavily involved in the establishment of the Medicare Hospice Benefit. ... [Dombi:] "... Hospice has been a very vibrant part of the health care world for quite a while now, but I think its energy levels are at an all-time high right now. And that’s energy levels in terms of not just public awareness and utilization of the services, but also the gained respect of recognizing that hospice is not a cottage industry anymore. Some people might label it as growing pains. I call it more of an evolution that naturally seems to occur in any field and in any organization."  [Continue reading ...]

[Austria] Influence of prior knowledge and experience on willingness to pay for home hospice services: a contingent valuation study International Journal of Health Economics and Management; Caroline Steigenberger, Andrea M Leiter, Uwe Siebert, Claudia Schusterschitz, Magdalena Flatscher-Thoeni; 3/25/25 Home hospice services contribute to dying in dignity by addressing medical and social needs at the end of life. ... We aim to quantify the benefits of home hospice services to society using society's monetary valuation and examine the influence of prior knowledge and experience on willingness to pay for home hospice services. A nationwide cross-sectional contingent valuation study was conducted in Austria. ... The two-part regression analysis showed a statistically significant positive impact on the probability of having a positive willingness to pay by prior knowledge of home hospice services, prior donations, and the wish of not dying alone. [Continue reading ...]Editor's note: Pair this research from Austria with today's USA post, "Medicare and 24-hour in-home hospice care: Is it covered?" Too often, we take for granted our Hospice Medicare payment system. Some choose to misuse it in ways that lead to fraud. This research reinforces openess to hospice services per "prior knowledge of home hospice services, prior donations, and the wish of not dying alone."

Medicare and 24-hour in-home hospice care​: Is it covered?Healthline; Medically reviewed by Shilpa Amin, MD, CAQ, FAAFP and written by Mandy French; 3/25/25... Medicare offers hospice coverage for beneficiaries. However, there are certain eligibilities and guidelines that they must meet. ...

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 ...] 

Hospice Medical Review Top Denial Reason Codes: Q4 2024 [Palmetto GBA]Palmetto GBA press release; 3/17/25We encourage all providers to review this information when filing claims to prevent denials and to ensure their claims are processed timely. The following information affects providers billing 81X bill types.  1 5CF36 Not Hospice Appropriate  2 56900 Auto Denial — Requested Records not Submitted  3 5CNER The Notice of Election Is Invalid Because It Doesn't Meet Statutory/Regulatory RequirementsSee the article for Top Ten.

‘Disturbing’ outlook: Hospices’ top regulatory concerns in 2025 Hospice News; by Holly Vossel; 3/20/25 Telehealth policies and program integrity concerns represent two of the leading regulatory issues on hospices’ radar this year. Regulatory changes and increasing oversight were the second-most cited concerns among nearly a quarter (21%) of 112 hospice professionals who participated in this year’s Outlook Survey by Hospice News and Homecare Homebase. Challenges around staffing and improved public awareness also topped the list of providers’ concerns. This is the third piece of this three-part Hospice News series that explores the significant regulatory challenges facing hospice providers in 2025. 

More care doesn't equal happier patients in traditional Medicare American Journal of Managed Care (AJMC); by Maggie L. Shaw; 3/17/25 The extremes of health care contact days—having too few or more than average—among community-dwelling beneficiaries 65 years and older of traditional Medicare have been associated with unnecessary care, misdirected care coordination, and excessive care outside the home, according to new research published online today in JAMA Internal Medicine. Health care contact days are days spent receiving care outside of the home. ... “Clinicians, researchers, and policymakers could use contact days to evaluate interventions and reduce excess contact days for patients,” the authors conclude, “by avoiding unnecessary care, improving care coordination, and shifting care to the home.”

Alliance Statement on MACPAC Report National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 3/18/25 On Thursday, March 13th, the Medicaid and CHIP Payment and Access Commission (MACPAC) released its semi-annual report, which included three chapters and five recommendations. (See analysis from the National Alliance for Care at Home HERE and HERE.) Two recommendations in the MACPAC report concern home and community-based services (HCBS):