Literature Review

Tracking the Medicare Provisions in the 2025 Reconciliation Bill | KFF KFF; updated 7/8/25 Similar to the chart for Medicaid provisions in the 2025 Reconciliation Bill, KFF also provides details on the changes for Medicare. Topics include eligibility policies, physician payment, prescription drugs, rules for Pharmacy Benefit Managers (PBMs), nursing homes – including the prohibition of implementation, administration, or enforcement of the minimum staffing levels requirement until October 1, 2034, and funding for HHS to “contract with AI contractors and data scientists to identify and reduce Medicare improper payments and recoup overpayments.Guest Editor’s Note, Judi Lund Person: The chart of Medicare provisions confirms that implementation of the Medicare eligibility and enrollment final rule will be delayed until October 1, 2034, except for those provisions that have already taken effect. The Senate version enacted into law also has a temporary one-year increase of 2.5% in the Physician Fee Schedule conversion factor for all services furnished between January 1, 2026 and January 1, 2027 and a delay of the nursing home staffing final rule until October 1, 2034. It is helpful to have the chart in a usable form for reference on the final bill enacted into law.

DOJ & HHS announce reinvigoration of False Claims Act Working Group and Healthcare Fraud Enforcement Priorities Dorsey & Whitney LLP; Press Release; 7/9/25 The Department of Justice and the Department of Health and Human Services announced the reinvigoration of a False Claims Act (“FCA”) Working Group, a joint effort between the two agencies.  The announcement was made on July 2 during remarks at the American Health Law Association (“AHLA”) Annual Meeting by Brenna Jenny, the new Deputy Assistant Attorney General of DOJ’s Commercial Litigation Branch, and in a press release that same day. This working group underscores that healthcare fraud is a priority for the Administration, despite recent staff changes and recent policy announcements about enforcement priorities in civil rights and DEI. It also underscores that robust compliance programs should continue to be a priority for healthcare-industry stakeholders.

Medicaid provisions threaten home and community-based services for millions of vulnerable Americans National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 7/3/25The National Alliance for Care at Home (the Alliance) issued the following statement today in response to the House’s passage of the “One Big Beautiful Bill Act,” also known as the Reconciliation bill, which now heads to President Trump’s desk for his signature. “The Alliance is deeply troubled by the Medicaid provisions within the One Big Beautiful Bill Act, which has passed both chambers of Congress and now awaits President Trump’s signature,” said Alliance CEO Dr. Steve Landers. “These provisions—including work requirements, reduced provider taxes, and new cost-sharing mandates—prioritize short-sighted budget savings over the health and wellbeing of our most vulnerable citizens who rely on home and community-based services (HCBS).” The home care community advocated throughout the legislative process for Congress to mitigate these harmful Medicaid provisions.

Alliance Statement on House passage of Reconciliation Bill: Medicaid provisions threaten home and community-based services for millions of vulnerable Americans National Alliance for Care at Home, Alexandira, VA and Washington DC; Press Release; 7/3/25 The National Alliance for Care at Home (the Alliance) issued the following statement today in response to the House’s passage of the “One Big Beautiful Bill Act,” also known as the Reconciliation bill, which now heads to President Trump’s desk for his signature. “The Alliance is deeply troubled by the Medicaid provisions within the One Big Beautiful Bill Act, which has passed both chambers of Congress and now awaits President Trump’s signature,” said Alliance CEO Dr. Steve Landers. “These provisions—including work requirements, reduced provider taxes, and new cost-sharing mandates—prioritize short-sighted budget savings over the health and wellbeing of our most vulnerable citizens who rely on home and community-based services (HCBS).”

The Alliance responds to Senate passage of Reconciliation Bill National Alliance for Care at Home, Alexandira, VA and Washington, DC; Press Release; 7/1/25 The National Alliance for Care at Home (the Alliance) issued the following statement today in response to the Senate’s passage of the “One Big Beautiful Bill Act,” also known as the Reconciliation bill. “The Alliance is alarmed by the Senate’s passage of the One Big Beautiful Bill Act, which prioritizes misplaced budget cuts over the health and wellbeing of our most vulnerable. The legislation will reduce access to care and support for the millions of Americans who rely on home and community-based services (HCBS),” said Alliance CEO Dr. Steve Landers. ... “The Alliance continues to maintain that the complexity of the Medicaid program makes it nearly impossible to reduce expenditures by the amounts contemplated by this legislation – potentially exceeding $1 trillion over ten years – without impacting services to older adults and people with disabilities. The Alliance will advocate on behalf of Medicaid enrollees, families, and providers nationwide ...

United Palliative & Hospice Care accused of $87M hospice scam Hospice News; by Jim Parker; 7/2/25 Three women associated with Houston-based United Hospice & Palliative Care (UPHC) have been charged with Medicaid and Medicare fraud after allegedly bilking more than $87 million in federal health care funds. The trio includes UPHC owner Dera Ogudo, an UPHC employee Victoria Martinez and a psychiatric hospital employee, Evelyn Shaw, ABC-13 Houston reported. The prosecutor’s indictment also includes an unnamed physician who allegedly received kickbacks for referrals to UPHC. “Ogudo and her co-conspirators preyed on the vulnerable residents of those group homes by enrolling them in hospice services with UPHC when they were not terminally ill,” the indictment indicated.

Nearly 50 charged in Southern District of Texas as part of national health care fraud takedown United States Attorney's Office - Southern District of Texas, Houston, TX; 6/30/25 A total of 22 cases are being announced as part of local efforts targeting health care fraud and include various schemes alleging unlawful distribution of controlled substances, some of which were diverted onto the black market, hospice fraud, kickbacks and other Medicare/Medicaid fraud schemes involving medically unnecessary genetic tests, durable medical equipment and more.  The charges filed in Southern District of Texas (SDTX) federal court are part of the Department of Justice’s 2025 national health care fraud takedown. ... One of the largest cases include three individuals for their alleged roles in a $110 million hospice fraud and kickback scheme. The charges allege Dera Ogudo, 39, and Victoria Martinez, 35, both of Richmond, operated hospice company United Palliative & Hospice Company (UPHC) that misled vulnerable elderly adults about what services were being billed to their Medicare and Medicaid plans.

Provider payment incentives: Evidence from the U.S. hospice industry ScienceDirect - Journal of Public Public Economics; by Norma B. Coe and David A. Rosenkranz; online ahead of print for August 2025 (retrieved from the internet 7/1/25) Highlights

Wisconsin author discusses her mother’s aging, dying in the American health care system: The long-term care system failed both her and her mother, she writes Wisconsin Public Radio; by Colleen Leahy; 6/27/25At age 99, Judy Karofsky’s mother was kicked out of her Wisconsin hospice facility. Within 48 hours of that decision, Karofsky became her mother’s default nurse. “I had to find a wheelchair for her. I had to keep track of her meds. I had to buy all the bandages and supplies that she would [need],” Karofsky told WPR’s “Wisconsin Today.” Karofsky is the author of “Diselderly Conduct: The Flawed Business of Assisted Living and Hospice.” In it, she chronicles nightmare scenarios as her mother aged and died in the American healthcare system: making her way through independent living, six different assisted living facilities, memory care, skilled nursing and hospice.  

Recommendations for palliative care program standards Center to Advance Palliative Care (CAPC); last updated 5/29/25CAPC has synthesized the NCP Guidelines into an operational summary for payers and policymakers to use in credentialing palliative care providers or informing minimum program requirements. These recommendations call for: an interdisciplinary team with 3 or more essential clinical disciplines: physician, advance practice provider, nurse, social worker, spiritual care professional and a child life specialist for programs serving children. One or more prescribers must have specialty certification in palliative care with others documenting some specialty training. PC services must include Comprehensive patient assessments, Pain and symptom management, Documented conversations about condition, treatment options, and goals of care, Psychological, social and spiritual support, Patient and family/caregiver education, and Coordination with behavior health and community health resources, and Development of a crisis intervention plan. The recommendations also specify 24/7 access to a prescribing clinician, clear discharge criteria, and routine evaluations of program quality.Guest Editor's Note, Ira Byock: These new recommendations from CAPC are timely and important. Building from the NCP Guidelines, CAPC is providing a framework for developing formal standards. That task is urgent given the pressures programs are under to reduce staffing, limit hours of service, and scope of services. I appreciate inclusion of crisis intervention planning, which should be a critical part of every palliative plan of care. The recommendations are strong, yet the statement’s wording is hesitant in tone. CAPC has the organizational stature to issue explicit minimum specifications for programs that purport to deliver palliative care. Health plans, payers, referring providers, and patients deserve assurance that such minimums are met or exceeded. CAPC has taken a significant step in the right direction.  

MedPAC Report: Medicare Advantage enrollees receive 11% fewer home health visits Home Health Care News; by Morgan Gonzales; 6/13/25 The Medicare Payment Advisory Commission’s (MedPAC) June report to Congress examined home health care use among Medicare Advantage (MA) and traditional Medicare patients and found that MA enrollees receive 11% fewer home health visits compared to Medicare fee-for-service. ... 

[Congressional Research Service] Medicare Coverage: Background and resources Congressional Research Service - In Focus; 6/13/25 This In Focus provides an overview of Medicare coverage of services and items, coverage determination processes, and core resources on these topics for beneficiaries, health care providers, and policymakers. ...

Chapter 6: Medicare’s measurement of rural provider quality MedPAC; 6/12/25 ... Because of low patient volumes in many rural health care settings, there are practical challenges in measuring some individual rural providers’ quality of care and in holding these providers accountable in quality reporting programs. ... The Commission acknowledged these difficulties when it established specific principles to guide expectations about quality in rural areas. These principles were developed with hospitals in mind but could be applied to other providers. ... [On page 4 of 40] Rural skilled nursing facilities and dialysis facilities had lower shares of providers with publicly reported quality results compared with their urban counterparts; in contrast, rural home health agencies and hospices had higher shares of providers with publicly reported quality results compared with their urban counterparts.Editor's Note: For ranking of hospices by quality scores, examine the National Hospice Locator, provided to the public by Hospice Analytics (a sponsor of this newsletter).