UnitedHealth Bribes Nurses
Medicaid United Health Bribery Update In the weeks since the below article revealed allegations against UnitedHealth, members of Congress are calling for action. At least one US Senator and two Representatives are engaged in the allegations. Senator Wyden (D-OR) announced that...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...Delay HOPE Tool
Advocacy by Kristin Rowan, Editor Advocacy Groups to CMS: Delay HOPE Tool Implementation “Delay HOPE Tool Implementation,” say multiple hospice advocacy groups. LeadingAge, the National Alliance for Care at Home (The Alliance), and the National Partnership for...Patient Data Access
Artificial Intelligence by Kristin Rowan, Editor Access to Patient Data Tighter than Fort Knox Access to patient data has always been tricky, even for the patient. Every doctor’s office, hospital, urgent care center, home health agency, and nursing facility uses their own system to...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...TEFCA and QHINs: Interoperability 2
Admin by Ben Rosen, Sr. Client Success Manager, Netsmart Interoperability What you need to know and how it affects you Part 2 For over two decades, tech companies and government agencies have been moving toward the goal of interoperability in healthcare technology. At long...BREAKING NEWS: House Passes Bill
Breaking News by Kristin Rowan, Editor House Passes Bill House passes bill in early-morning vote. The House of Representatives, predictably split along party lines, passed the “Big, Beautiful Bill” in a 215-214 narrow win. All but three Republican representatives...Pushback on Trump Initiatives
Regulatory by Kristin Rowan, Editor Pushback on Trump Initiatives From All Sides Pushback on Trump initiatives, including the steep cuts to Medicare, Medicaid, Social Security, and VA benefits erupted this week. Coalitions, associations, and members of Congress seek to stop the...Shoot the Messenger
Admin by Elizabeth E. Hogue, Esq. Shoot the Messenger at Your Own Risk Shoot the messenger of fraud and abuse at your peril. Providers must take seriously the concerns of employees about possible fraudulent and abusive practices. Most whistleblowers take their concerns to...Interoperability
Clinical by Ben Rosen, Sr. Client Success Manager, Netsmart Interoperability What you need to know and how it affects you For over two decades, tech companies and government agencies have been moving toward the goal of interoperability in healthcare technology. At long last,...DOJ Rejects Plan
M&A by Kristin Rowan, Editor DOJ Rejects Plan to Divest Assets DOJ rejects plans to divest assets from UnitedHealth and Amedisys to BrightSpring Health Services and the Pennant Group. Last week, we reported that Amedisys and UnitedHealth had entered an agreement to divest...Update is Not an Increase
Hospice by Kristin Rowan, Editor Updates to Hospice Rule On April 11, 2025, the Centers for Medicare and Medicaid Services (CMS) issued their proposed rule for hospice rates, Conditions of Participation (CoPs) and face-t0-face encounter requirements for FY 2026. The proposed...Medicaid Cuts Remain Unknown So Far
CMS by Tim Rowan, Editor Emeritus "Life and Death" Medicaid Cuts are Looming We don’t need to cut benefits, and it really infuriates me to hear people here talking about that because it stresses people out. This is life and death for them. –Senator Bernie Moreno...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...
