Fraudsters Arrested, Oz Issues Warning
CMS by Kristin Rowan, Editor Fraudsters Arrested, Oz Issues Warning Fraud in California Fraudsters arrested in West Covina, CA this week were allegedly running a Medicare scheme. Authorities arrested hospice owner-operator Normita Sierra. They charged her with nine counts...Medicare Advantage Audits
CMS by Kristin Rowan, Editor CMS Strategy for Medicare Advantage Audits Last week, The Centers for Medicare and Medicaid Services (CMS) rolled out a new, aggressive strategy to enhance and accelerate Medicare Advantage Audits under RADV. CMS will audit all eligible MA...Trouble in MA Paradise?
Advocacy by Kristin Rowan, Editor Medicare Advantage It’s no secret within the care at home community that Medicare Advantage is not without its problems. Coverage and care are good when the beneficiary is relatively healthy. When it’s really needed, MA plans deny...Vision for CMS
CMS by Kristin Rowan, Editor Vision for CMS from Dr. Oz Last week, Dr. Mehmet Oz issued a statement on his vision for the future of CMS. Dr. Mehmet Oz is a cardiothoracic surgeon and former host of his own TV show. Under the Department of Health and Human Services, CMS...Industry Update
Admin by Kristin Rowan, Editor Industry Update with Dr. Steve Landers At last week’s New England Home Care & Hospice Conference, Dr. Steve Landers, President of The National Alliance for Care at Home (The Alliance) gave the keynote address and offered some...That’s a No-No
Admin by Elizabeth E. Hogue, Esq. No-no # 1 “No-No” may seem like something you would say to a toddler, but there is a list of things agency owners do that they should not do. Many of these are things providers may not often consider. This article focuses on the...MedPAC Comments on CY 2026
CMS by Kristin Rowan, Editor MedPAC Comments on CY 2026 MedPac Sends Recommendations to Congress MedPAC makes recommendations to Congress and HHS on issues affecting the Medicare program. The March report for 2025 includes recommendations for hospice, home health, and...Update on Public Participation in Rule Making
Advocacy by Kristin Rowan, Editor Update Last week, we reached out to some of our contacts for responses to this change. Former President of NAHC and current Senior Counsel at Arnall Golden Gregory Bill Dombi said: It is difficult to discern the impact of the rescission of the...Humana Thyme Agreement
Clinical by Kristin Rowan, Editor Palliative Care for Medicare Advantage Members Cancer is one of the highest leading causes of death in the United States, second only to heart disease. The challenges for cancer patients are not only physical, but emotional and financial as...Prior Authorization Requirement Removed by UnitedHealthcare
Clinical by Kristin Rowan, Editor Easier Access to Home Health Prior authorization requirements can be cumbersome, delaying or even preventing care in some cases. Patients who need prior authorization to get he care they need also generally have form after form to fill out or...BREAKING NEWS: Kennedy Rescinds Public Participation in Rule Making
Advocacy by Kristin Rowan, Editor Public Participation Rescinded The Administrative Procedure Act (APA) requires that an agency public a notice of proposed rulemaking in the Federal Register; allow sufficient time for public participation via written data, views, or arguments;...Treatment in Place from Emergency Medical Services
Clinical by Elizabeth E. Hogue, Esq. Treatment in Place Providers of services to patients in their homes are anecdotally familiar with situations in which patients need help at home, but do not qualify for home health services and have not arranged for or are unable to afford...Medicare Advantage Lowers Home Health Care Use
Hospice by Kristin Rowan, Editor End-of-Life Care in Medicare Advantage vs Traditional Medicare Using research from CMS, researchers from Mt. Sinai in New York and Brown University in Rhode Island studied the data of adults aged 66 and older who passed away and had Medicare...Medicare Advantage Increase for Payers, not Providers
Artificial Intelligence by Kristin Rowan, Editor CMS Announces Medicare Advantage Pay Hike On January 13, 2025, CMS announced its plans to increase payments to Medicare Advantage plans by 4.33%. Policy changes for Medicare Advantage and Part D include changes in how the agency calculates...
