Literature Review
All posts tagged with “Regulatory News.”
HHS unveils major revamp to shift health data, AI strategy and policy under ONC
07/31/24 at 03:00 AMHHS unveils major revamp to shift health data, AI strategy and policy under ONC Fierce Healthcare; by Emma Beavins; 7/25/24 The Office of the National Coordinator for Health Information Technology (ONC) has been renamed and restructured, the Department of Health and Human Services (HHS) announced [July 25]. The restructuring will affect technology, cybersecurity, data and artificial intelligence strategy and policy functions. The agency will be renamed the Office of the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology (ASTP/ONC). Head of ONC, Micky Tripathi, will hold the new title of assistant secretary for technology policy in addition to his title of national coordinator for health IT. ... Under ASTP, there will be an Office of Policy, an Office of Technology, an Office of Standards, Certification and Analysis and an Office of the Chief Operating Officer.
How Medicare Advantage, traditional Medicare differ on end-of-life care
07/30/24 at 03:00 AMHow Medicare Advantage, traditional Medicare differ on end-of-life care Becker's Payer Issues; by Rylee Wilson; 7/24/24 Medicare Advantage enrollees were less likely to receive burdensome treatments or transfers in the last months of life compared to their peers in traditional Medicare, a study published July 19 in JAMA Health Forum found. MA beneficiaries were less likely to die in a hospital than their counterparts in traditional Medicare, the study found. MA enrollees were more likely to receive home-based care at the end-of-life. This home-based care can improve quality but can also leave patients without adequate assistance after a hospitalization, the study's authors wrote. Though Medicare Advantage beneficiaries were less likely to be hospitalized during the last months of life than their counterparts in traditional Medicare, once hospitalized, MA enrollees were more likely to die in the hospital and less likely to be discharged to rehabilitative or skilled nursing facilities.
HIMSSCast: Improving patient safety and employee retention with best incident reporting practices
07/29/24 at 03:00 AMHIMSSCast: Improving patient safety and employee retention with best incident reporting practicesHealthcare IT News; by Andrea Fox; 7/26/24 By modernizing systems and improving leadership and culture to embrace reporting, healthcare organizations can better address the top 10 patient safety concerns for 2024, says Heidi Raines, founder and CEO of Performance Health Partners. Ultimately improving the quality of care healthcare systems deliver and preventing harm requires a degree of self-reflection. Along with digital transformation, putting an easy-to-use incident reporting system in place can help healthcare organizations address today's chief patient safety concerns, including medication errors, care delays, workplace violence and preventing patient falls, said Raines.
Medicare physician pay has plummeted since 2001. Find out why.
07/25/24 at 03:00 AMMedicare physician pay has plummeted since 2001. Find out why. American Medical Association - AMA; by Tanya Albert Henry; 7/17/24 Medicare physician payment—often called Medicare reimbursement—must be tied to an inflation index called the Medicare Economic Index (MEI). As part of its campaign to fix the unsustainable Medicare pay system, the AMA has outlined in a quick, easily navigable fashion why this payment fix needs to happen now. ... The AMA’s two-page explainer on the Medicare Economic Index (PDF) outlines how it incorporates these two categories reflecting the resources used in medical practices:
Why home health providers should expect to see a ‘less draconian’ final payment rule
07/25/24 at 03:00 AMWhy home health providers should expect to see a ‘less draconian’ final payment rule Home Health Care News; by Joyce Famakinwa; 7/22/24 As home health providers continue to digest the proposed payment rule for 2025, National Association for Home Care & Hospice (NAHC) President William A. Dombi believes that the industry will ultimately see a comparatively toned down final rule. “We believe we will not end up with this proposed rule as a final rule,” he said during the opening presentation at NAHC’s Financial Management Conference in Las Vegas on Sunday. “We will end up with something less draconian. The cuts will be reduced because, No. 1, that’s what they’ve done for the last several years, and, No. 2, it’s an election year.” Even with a prediction of a “less draconian” final payment rule, NAHC is still gearing up to fight against home health cuts and the Centers for Medicare & Medicaid Services’ (CMS) payment-setting methodologies.
Local whistleblowers help in federal hospice investigation
07/24/24 at 03:00 AMLocal whistleblowers help in federal hospice investigation CBS WKBN-27, Austintown, OH; by Patty Coller; 7/22/24 The parent company that operates a hospice provider in Austintown has agreed to a settlement in a federal lawsuit alleging that the local location, along with others in the southern part of the country, defrauded the government, according to federal prosecutors. Gentiva, formerly known as Kindred at Home, has agreed to pay $19 million to resolve allegations that it and other entities of Gentiva knowingly submitted, or caused to be submitted, false claims for hospice services provided to patients who were ineligible for hospice benefits under Medicare and other federal health care programs because the patients were not terminally ill, according to Department of Justice. ... The Employment Law Group said in a news release that there were 20 whistleblowers in the case, including two from the Youngstown area involving SouthernCare, who helped to recover about $2.13 million in alleged fraudulent billing.
Vital Signs: Digital Health Law Update | Spring 2024
07/24/24 at 03:00 AMVital Signs: Digital Health Law Update | Spring 2024 Jones Day - Vital Signs; by Vital Signs' Editors; July 2024Welcome to Vital Signs, a curated compilation of the latest legal and regulatory developments in digital health. [Topics include the following:]
How well does Medicare cover end-of-life care? It depends on what type
07/23/24 at 03:00 AMHow well does Medicare cover end-of-life care? It depends on what type Medical Xpress; by Mark Harden, CU Anschutz Medical Campus; 7/19/24 Not all versions of Medicare are created equal—and when it comes to end-of-life care, some versions may serve a patient's needs better than others. That's the focus of newly published research by Lauren Hersch Nicholas, Ph.D., MPP, a University of Colorado Department of Medicine and CU Cancer Center health economist, and her colleagues. The researchers analyzed the experiences of more than a million people receiving Medicare-funded services in the last six months of their lives. ... Their paper was published July 19 in JAMA Health Forum. What Nicholas and her colleagues found is that the kind of Medicare a patient is enrolled in can make a difference in whether that patient gets certain treatments, and whether the patient dies in a hospital or in hospice care.
Texas pharmaceutical marketer sentenced for $59 million medications fraud conspiracy
07/23/24 at 03:00 AMTexas pharmaceutical marketer sentenced for $59 million medications fraud conspiracy ArentFox Schiff; by D. Jacques Smith, Randall A. Brater, Michael F. Dearington, Nadia Patel, Hillary M. Stemple, Mattie Bowden, Elizabeth Satarov; 7/19/24 On July 12, Quintan Cockerell, a Texas pharmaceutical marketer, was sentenced to over two years in prison and ordered to pay more than $59 million for receiving illegal kickbacks in exchange for prescription referrals for compounded medications intended to be made specific for individual patient needs. ... Court documents and evidence presented at trial demonstrated that Cockerell used preloaded prescription pads and “standing orders” for doctors to easily select expensive compounded medications. The pharmacy could then switch ingredients in the medications actually prescribed by doctors to maximum insurance reimbursements.
‘Bad apples in a barrel’: How fraudsters in home health care impact the entire space
07/23/24 at 02:00 AM‘Bad apples in a barrel’: How fraudsters in home health care impact the entire space Home Health Care News; by Joyce Famakinwa; 7/19/24 The home health industry has its very own boogeyman--the bad actor. However, there's a difference between providers that had made errors in claims ... [Subscription required to continue reading]
Does Medicare pay for dementia care? Here’s what coverage you can expect for treatments and therapies
07/22/24 at 03:00 AMDoes Medicare pay for dementia care? Here’s what coverage you can expect for treatments and therapies Aol - Fortune; by Margie Zable Fisher; 7/18/24 Age-related memory loss is common, but more serious memory problems may be a sign of dementia, which is not a normal part of aging. ... Dementia patients have a variety of medical issues. “In addition to symptoms related to dementia, the overwhelming majority of dementia patients have one or more chronic health conditions,” says Matthew Baumgart, Vice President of Health Policy, at the Alzheimer's Association. Medicare (and Medicare Advantage) provide some coverage for dementia, beginning with the diagnosis, says Baumgart. [Click on the title's link for practical, user-friendly information about what Medicare provides arose the trajectory of dementia's progression. CMS's new GUIDE pilot program is described.]
Glitzy Scottsdale couple jailed in $900M fraud
07/16/24 at 03:15 AMGlitzy Scottsdale couple jailed in $900M fraud Gilbert Sun News; by Tom Scanlon; 7/14/24 ... According to a federal indictment, “Alexandra Gehrke and Jeffrey King were charged for targeting elderly Medicare patients, many of whom were terminally ill in hospice care, for medically unnecessary wound grafts.” Gehrke – known to friends and associates as “Lexie” – and King allegedly filed $900 million in fraudulent claims, pocketing “$330 million in illegal kickbacks as a result of their fraudulent scheme.” According to the indictment, they were responsible for “allograft” bandages being applied frivolously to hundreds of patients, many of them dying. According to Gehrke’s LinkedIn profile, “APEX Medical is a national medical device distribution company.
The Medicare Post-Acute Care and Hospice Provider Public Use File (PAC PUF)
07/16/24 at 03:00 AMThe Medicare Post-Acute Care and Hospice Provider Public Use File (PAC PUF)CMS press release; 7/10/24[This file] provides information on services provided to Medicare beneficiaries by home health agencies (HHAs), hospices, skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and long-term care hospitals (LTCHs). It contains information on demographic and clinical characteristics of beneficiaries served, professional and paraprofessional service utilization, submitted charges, and payments at the provider, state, and national levels. Additionally, the PAC PUF includes payment information at the case-mix grouping level for HHAs, SNFs, and IRFs.
[CMS CAHPS Hospice Survey] Agency Information Collection Activities: Submission for OMB Review; Comment Request
07/15/24 at 03:00 AM[CMS CAHPS Hospice Survey] Agency Information Collection Activities: Submission for OMB Review; Comment Request Federal Register; A Notice by the Centers for Mediare & Medicaid Services; 7/9/24 Type of Information Collection Request: Revision of a currently approved collection; Title of Information Collection: CAHPS Hospice Survevy; Use: CMS launched the development of the CAHPS Hospice Survey in 2012. Public reporting of the results on Hospice Compare started in 2018. The goal of the survey is to measure the experiences of patients and their caregivers with hospice care.
Chevron deference derailed
07/15/24 at 03:00 AMChevron deference derailed The Rowan Report; by Kristin Rowan; 7/12/24 ... Chevron Deference in Home Health: Since the advent of the PDGM model, CMS has calculated payment rates based on its interpretation of budget neutrality. The National Association for Home Care and Hospice [NAHC] has disputed the validity of both the interpretation of budget neutrality and the formulas used to calculate it. Last year’s 2024 CMS Proposed Rule cut payment rates even further with a 2.890% Budget Neutrality permanent payment rate adjustment and a temporary rate adjustment to account for alleged overpayments from 2020-2022. The lawsuit filed against CMS in response to the 2024 Final Rule was dismissed. NAHC began pursuing an administrative review with CMS. [Click on the title's link to continue reading the discourse between CMS and NAHC, specific to home health.]
C-TAC: CMS’ ‘Palliative’ Definition in 2025 Proposed Hospice Rule ‘Misaligned, Problematic’
07/15/24 at 03:00 AMC-TAC: CMS’ ‘Palliative’ Definition in 2025 Proposed Hospice Rule ‘Misaligned, Problematic’ Hospice News; by Holly Vossel; 7/12/24 Efforts to establish potential payment mechanisms for high-acuity palliative services within the Medicare Hospice Benefit will require greater clarity from regulators, according to the Coalition to Transform Advanced Care (C-TAC). The U.S. Centers for Medicare & Medicaid Services’ (CMS) 2025 proposed hospice payment rule contained a request for information (RFI) on the potential implementation of reimbursement pathways for “high intensity palliative care services,” such as chemotherapy, blood transfusion and dialysis. CMS in its proposed rule indicated that, “Hospice care changes the focus of a patient’s illness to comfort care (palliative care) for pain relief and symptom management from a curative type of care.” C-TAC’s recommendations are as follows: [Click on the title's link to read more.]
All the payment factors included in the 2025 Home Health Proposed Rule
07/11/24 at 03:00 AMAll the payment factors included in the 2025 Home Health Proposed Rule Home Health Care News; by Joyce Famakinwa; 7/8/24 Providers examining the 2025 home health proposed payment rule may be experiencing some déjà vu, according to William A. Dombi, the president of the National Association for Home Care & Hospice’s (NAHC). “Much of what we see in the rule is just, on the payment side of it in particular, an update from ‘23 and ‘24,” he said during a recent webinar hosted by NAHC. On June 26, the U.S. Centers for Medicare & Medicaid Services (CMS) unveiled its home health proposed payment rule for 2025. The proposal includes a payment decrease in the aggregate by 1.7%, or by about $280 million. “That needs qualification,” Dombi said. “That’s $280 million, not to what it would otherwise have been, but rather, in contrast to what it’s expected to be for 2024.” Providers examining the proposed rule will also see a 2.5% net inflation rate update. ...
Home health providers to pay $4.5M to resolve alleged false claims act liability for providing kickbacks to assisted living facilities and doctors
07/10/24 at 03:00 AMHome health providers to pay $4.5M to resolve alleged false claims act liability for providing kickbacks to assisted living facilities and doctorsDOJ press release; 7/1/24Guardian Health Care Inc., Gem City Home Care LLC and Care Connection of Cincinnati LLC, home health agencies operating in Texas, Ohio and Indiana, along with their owner Evolution Health LLC, have agreed to pay $4,496,330 to resolve allegations that they violated the False Claims Act by knowingly providing illegal kickbacks to assisted living facilities and physicians in exchange for Medicare referrals.
Long-term care providers among 193 criminally charged, $2.75 billion in fraud recoveries so far in 2024
07/10/24 at 02:00 AMLong-term care providers among 193 criminally charged, $2.75 billion in fraud recoveries so far in 2024McKnight's Senior Living; by Kathleen Steele Gaivin; 7/1/24The Justice Department has recovered more than $2.75 billion in false claims against healthcare providers and charged 193 defendants so far this year in criminal cases through its 2024 National Health Care Fraud Enforcement Action, and many of the cases involve nursing homes, home health or hospice agencies, and assisted living providers, according to a Thursday report from the department’s criminal division.
Medicare Program: End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, etc.
07/08/24 at 03:00 AMMedicare Program: End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, etc. Federal Register; Proposed Rule by the Centers for Medicare & Medicaid Services; 7/5/24
Survey: Adults dropped from Medicaid after pandemic faced healthcare access, affordability issues
07/08/24 at 03:00 AMSurvey: Adults dropped from Medicaid after pandemic faced healthcare access, affordability issues CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota; by Mary Van Beusekom, MS; 7/2/24 A survey of low-income adults in four southern US states shows that nearly half of those disenrolled from Medicaid after COVID-19 pandemic protections ended had no insurance in late 2023, leading to struggles to afford healthcare and prescription drugs and threatening to broaden a gap that had narrowed during expanded governmental benefits. The data were derived from 89,130 adult residents of Arkansas, Kentucky, Louisiana, and Texas participating in the National Health Interview Survey in 2019, 2021, and 2022. In 2023, states rechecked Medicaid eligibility after COVID-19 governmental protections expired, disenrolling millions. The average participant age was 48.0 years, and 51.6% were women. Researchers from Beth Israel Medical Center and Harvard Medical School published the results late last week in JAMA Health Forum.
CMS Office of Minority Health: Advance health equity through accessibility
07/08/24 at 03:00 AMCMS: Advance health equity through accessibility CMS.gov; posted for July 2024 Throughout July, the Center for Medicare & Medicaid Services Office of Minority Health (CMS OMH) celebrates Disability Pride Month and the anniversary of the Americans with Disability Act (ADA). Twenty-seven percent of adults in the United States have some type of disability, with mobility (serious difficulty walking or climbing stairs) and cognitive (serious difficulty concentrating, remembering, or making decisions) disabilities being the most prominent types. Individuals living with disabilities often face worse overall health outcomes, including likelihood of obesity (41.6%), diabetes (15.9%), and heart disease (9.6%). ... Find these resources on our health observance page this month or our Improving Access to Care for People with Disabilities page all year long.
10 key Medicare Advantage updates in 2024
07/08/24 at 03:00 AM10 key Medicare Advantage updates in 2024 Becker's Payer Issues; by Rylee Wilson; 6/27/24 The first half of 2024 brought shifting trends for Medicare Advantage. Payers continued to warn of rising medical costs in the MA population, and some are predicting they will lose members next year. Insurers picked up a win in June when CMS said it would recalculate star ratings for 2024. Here are 10 key Medicare Advantage updates to know:
States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model
07/08/24 at 02:00 AMStates Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model CMS.gov; 7/2/24 On July 2, 2024 CMS announced that Connecticut, Maryland, and Vermont will be the first state participants in the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. Hawaii will also participate, pending satisfaction of certain requirements. Applications to participate in Cohort 3 of the model are due August 12, 2024 at 3:00 p.m. EST (Cohort 3). Eligibility requirements and additional model details can be found in the NOFO. To stay up to date on model announcements, events, and resources, please sign up for the AHEAD Model listserv.
DOJ slaps $20M opioid prescription penalty on OptumRx
07/05/24 at 03:00 AMDOJ slaps $20M opioid prescription penalty on OptumRx Fierce Healthcare; by Noah Tong; 7/2/24 OptumRx will pay $20 million to resolve claims the company violated the Controlled Substances Act by improperly filling certain opioid prescriptions, the Department of Justice recently announced. The agency claims OptumRx did not fill prescriptions correctly for "trinity prescriptions" like benzodiazepines and other muscle relaxants from April 2013 to April 2015. These prescriptions, which are addictive, may not have been “intended for legitimate medical use” and carry “significant risk of harm,” according to a news release. “Pharmacies providing opioids and other controlled substances have a duty under the Controlled Substances Act to ensure that they fill prescriptions only for legitimate medical purposes,” said Principal Deputy Attorney General Brian Boynton, head of the Justice Department’s Civil Division, in a statement. “The department will continue to work with its law enforcement partners to ensure that pharmacies do not contribute to the opioid addiction crisis.”