Literature Review

CMS ramps up efforts to root out ‘door knocker’ hospice schemes Hospice News; by Holly Vossel; 11/15/24 The U.S. Centers for Medicare & Medicaid Services (CMS) recently elaborated on its plans to expand public education campaigns designed to help protect hospice beneficiaries from fraudulent actors in the space. ... “One of the areas we’re working with right now is to enhance education — beneficiary education specifically,” Pryor said during a recent CMS webinar. “We have hospice beneficiaries who are unfortunately fraudulently signed up for the benefit in these kind of, what we call, ‘door knocker scams.’” The scams include bad actors reaching out to beneficiaries with offers of free goods and services, such as groceries, TVs, reclining chairs and furniture, Pryor explained. The fraudulent marketing tactics are posing significant complications for Medicare beneficiaries, he said.

Homecare owner allegedly withholds $86k in wages HomeCare, Indianapolis, IN; 11/11/24 The U.S. Department of Labor (DOL) has alleged that home health care company owner Hahn March violated federal wage laws and withheld $86,000 in wages by using improper pay practices at her two Indianapolis, Indiana, companies: Signal Health Group Inc. and SHG Employee Leasing Company. In 2018, federal investigators cited March for not paying overtime wages to employees at her then-owned company, Aging and Disabled Home Healthcare. ... The complaint was filed following an investigation by the DOL Wage and Hour Division, which discovered March and Nancy Stanley, the chief financial officer of both companies, used an artificial regular rate pay scheme to lower hourly pay rates and, in turn, shortchanged employees $86,427 in overtime wages. ... The DOL is seeking $172,854—including $86,427 in back wages and an equal amount in liquated damages—for 43 current and former employees. ... “Employees who work in home health care—one of our nation’s lowest-paying professions—provide necessary daily and hospice care that allow individuals to remain in their homes and aid them in navigating their basic needs, providing dignity and comfort to clients and their families,” said Aaron Loomis, Wage and Hour Division district director.

Addus leaders dive further into Gentiva deal, ‘historically low’ turnover rates Home Health Care News; by Joyce Famakinwa; 11/5/24 Completing the acquisition of Gentiva’s personal care operations is still top of mind at Addus HomeCare Corp. (Nasdaq: ADUS). The $350 million transaction was first announced in June. Addus Chairman and CEO Dirk Allison explained how he believes the deal will better position the company for the impacts of the “Ensuring Access to Medicaid Services” rule. “We believe our personal care segment benefits from both scale and broad geographic coverage in the states where we operate,” Allison said Tuesday during the company’s third-quarter earnings call. ..."

New FTC regulations could create obstacles for hospice M&A Hospice News; by Jim Parker; 10/24/24 Changes to federal rules governing mergers and acquisitions could have sweeping effects on hospice and other health care transactions. The Federal Trade Commission (FTC) recently finalized a rule that will implement changes to required pre-merger notification forms. Pursuant to the Hart-Scott-Rodino Act, parties to certain transactions must submit these documents to the FTC and other regulatory agencies to help identify and address potential antitrust concerns. The law requires that transactions exceeding $120 million must submit the form, which agencies will use to conduct a 30-day premerger assessment, according to Luke Smith, member at the law firm Bass, Berry and Sims. The final rule will likely complicate the closing of some hospice acquisitions.

What hospices need to know about whistleblower lawsuits Hospice News; by Holly Vossel; 10/22/24 Hospices need to understand the range of risks involved in qui tam cases and how best to navigate whistleblower concerns amid an evolving regulatory landscape. Qui tam actions occur when a whistleblower, called a “relator” by the courts, files a False Claims Act suit on behalf of the government. The relator has the potential to receive a portion of any funds recovered by the government via the lawsuit, with amounts typically ranging from 15% to 25%. A federal judge recently found the qui tam clause unconstitutional, ruling that the relator’s role in sparking enforcement actions effectively makes them an executive branch officer appointed without due process.

Leveraging sales strategies in hospice payment cap management Hospice News; by Jim Parker; 10/22/24 Errors or other inconsistencies with the payment cap can have significant consequences for providers, and sales and marketing staff can help hospices achieve a healthy balance. The cap is designed to prevent overuse of hospice, put controls on Medicare spending and foster greater access to care among patients. For Fiscal Year 2024, the U.S. Centers for Medicare & Medicaid Services set the cap at $33,394. In 2025, this will rise to $34,465. If a hospice has a cap liability, they will have to repay that amount to Medicare. In some situations, a hospice might face additional monetary penalties, interest charges or referrals to the U.S. Treasury Department in severe cases.

CMS grants temporary relief for home health, hospice agencies affected by hurricane McKnights Home Care; by Adam Healy; 10/15/24 The Centers for Medicare & Medicaid Services has issued several temporary flexibilities intended to help hospices and home health agencies affected by Hurricane Helene continue to provide care amid the emergency. During the emergency period, home health providers may take advantage of extended deadlines for quality reporting and patient assessment requirements, according to CMS. The agency communicated last week that it would permit delayed Outcome and Assessment Information Set submissions, and it also extended the five-day completion requirement for patients’ comprehensive assessments to 30 days. These patients assessments may also be conducted remotely or by record view — a departure from the typical in-person requirement — during the temporary emergency period. CMS said that this change will allow patients to be cared for in the environment of their choice, reduce impacts on acute care and long-term care facilities, and maximize clinicians’ ability to care for patients with the greatest acuity.

New CMS Medicaid, CHIP Guidance could help clarify pediatric palliative care payment Hospice News; by Holly Vossel; 10/15/24 The Centers for Medicare & Medicaid Services (CMS) recently released new guidelines intended to better support state-based pediatric reimbursement systems and help improve equitable health access among youth populations. The new guidance includes best practices for state Medicaid programs and the Children’s Health Insurance Program (CHIP) to implement and comply with early and periodic screening, diagnostic and treatment (EPSDT) coverage requirements. One of the most significant challenges confronting children living with serious illness and their families is the heterogeneity of policies and programs across the country, said Allison Silvers, chief health care transformation officer at the Center to Advance Palliative Care (CAPC). ...

Millions of aging Americans are facing dementia by themselves California Healthline; by Judith Graham; 10/15/24 Sociologist Elena Portacolone was taken aback. Many of the older adults in San Francisco she visited at home for a research project were confused when she came to the door. They’d forgotten the appointment or couldn’t remember speaking to her. It seemed clear they had some type of cognitive impairment. Yet they were living alone. Portacolone, an associate professor at the University of California-San Francisco, wondered how common this was. Had anyone examined this group? How were they managing? ... Portacolone got to work and now leads the Living Alone With Cognitive Impairment Project at UCSF. The project estimates that that at least 4.3 million people 55 or older who have cognitive impairment or dementia live alone in the United States. ... Imagine what this means. ...

Hospice care home provides peaceful place for low-income or homeless to die Indiana Capital Chronicle; by Elise Shrock; 10/10/24 My neighborhood is full of wonderful places. Lovely places where people go to worship, to meet for meals, to do their errands, and, a lovely place to die. Let me explain. Tucked behind the busy near-north Keystone corridor is the Abbie Hunt Bryce Home, a no-cost home for terminally ill individuals who are low-income or homeless and would have no other home to go to during their last days or months of life. Operated by Morning Light, LLC, Abbie Hunt Bryce Home offers critical and compassionate services to Hoosiers in their final days. As the second largest residential hospice in the nation, our state is positioned to be a leader in providing compassionate end-of-life care. Not only is the Home a leader in size and scope, but all hospice residents stay free of charge, with no payment or insurance required. The Home is supported solely by community support and qualifies for Medicaid Waiver. ... [A case study follows with "Systemic challenges in Indiana." ...]

CMS finalizes rule to curtail major DME fraud concernsMcKnight's Home Care; by Adam Healy; 9/26/24The Centers for Medicare & Medicaid Services finalized a rule this week that will help it better track anomalous and highly suspicious billing activity for durable medical equipment. The rule allows CMS to more closely monitor two Healthcare Common Procedure Coding System (HCPCS) billing codes for urinary catheters: A4352, an intermittent urinary catheter with a curved tip, and A4353, an intermittent urinary catheter with insertion supplies. These two billing codes were behind what may be the largest case of Medicare fraud in the program’s history. In February, the National Association of ACOs (NAACOS) uncovered evidence that fraudsters had used the two codes to loot as much as $3 billion or more from government health programs.

Maryland to drop Kaiser as Medicaid administrator Becker's Hospital CFO Report; by Jakob Emerson; 9/23/24 Maryland will drop Kaiser Permanente as a Medicaid managed care organization in 2025. "After some lengthy contract negotiations, the [Maryland] Department of Health has elected not to enter into a contract with Kaiser and we are working to ensure a seamless transition of those enrollees to other health plans," MDH's deputy secretary of healthcare finance, told local radio station WYPR on Sept. 20. ... "If we are not able to participate in Medicaid, it would interrupt the highest-rated care and coverage of our more than 113,000 Medicaid members in Maryland in 2025," a spokesperson for Kaiser told Becker's. "We will continue to work with the Maryland Department of Health so we can continue serving this community for decades to come." According to WYPR, the state will renew its existing managed care contracts, which includes Aetna, CareFirst BCBS, UnitedHealthcare, Elevance Health's Wellpoint, Jai Medical Systems, Maryland Physicians Care, MedStar Family Choice and Priority Partners.

Heart disease, cancer remain leading causes of death in US Becker's Hospital Review; by Elizabeth Gregerson; 8/9/24 Heart disease and cancer remained the leading causes of death in 2023, according to provisional data released Aug. 8 by the CDC. Mortality data is collected by the National Center for Health Statistics National Vital Statistics System from U.S. death certificates, according to an analysis published Aug. 8 in JAMA. After a sharp increase in the rate of deaths from heart disease during the pandemic, the 2023 rate (162.1) reportedly was closer to pre-pandemic levels (161.5). The rate of deaths from cancer decreased from 146.2 in 2019 to 141.8 in 2023. Cause of death data is based on the underlying cause of events leading to death. Death rate is recorded as the age adjusted death rate per 100,000 deaths, authors of the JAMA analysis said.