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States Go Beyond Federal Requirements To Fight Medicaid Home Care Fraud
States are going beyond federal requirements to detect fraud in Medicaid home care, cross-checking billed services against electronic visit verifications (EVVs) and analyzing claims for specific...
View ArticleOwner Of Home Health Fiscal Intermediary, Adult Day Sentenced For $64M...
On Wednesday, a Brooklyn federal court sentenced the owner of adult day and home health companies to 76 months in prison for leading a multiyear Medicaid fraud and illegal kickback scheme that...
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VNA Health Group, Empath Health Maintain Communications Strategies Amid Home...
This article is a part of your HHCN+ Membership As the Centers for Medicare & Medicaid Services (CMS) and Department of Justice (DOJ) intensify anti-fraud enforcement in the home health industry,...
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Support and Suspicion: What Home Health Bill Shows About DC’s Stance On Sector
This article is a part of your HHCN+ Membership Last week, Sen. Susan Collins (R-Maine) introduced a bill that would reset the home health base payment rate and give the Centers for Medicare &...
View ArticleDOJ Names Home Health, Hospice Among Top Fraud Enforcement Priorities
The United States Department of Justice (DOJ) Fraud Division named home health and hospice as among its top enforcement priorities and plans to use innovative data analysis to target fraud schemes in...
View ArticleNew Bill Would Reset Home Health Payment Rates, Give CMS New Fraud-Fighting...
Sen. Susan Collins (R-Maine) has introduced a bill that, if enacted, would give the Centers for Medicare & Medicaid Services (CMS) additional tools to prevent and detect home health fraud and...
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AI, Fraud And New Leadership: The Shifts Reshaping Home-Based Care
This article is a part of your HHCN+ Membership The home-based care industry is shifting fast, with major leadership changes, new technologies changing the operational game and a significantly...
View ArticleDOJ Charges 19 In Alleged $4M Medicaid, Medicare At-Home Care Fraud Scheme
The United States Department of Justice (DOJ) Fraud Division, U.S. Attorney’s Office and Pennsylvania Attorney General have charged 19 defendants for a $4 million fraudulent Medicare and Medicaid...
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‘Matching The Market’ On Medicare Advantage One Key To Choice Health at...
This article is a part of your HHCN+ Membership Choice Health at Home’s CEO, David Jackson, envisions his rapidly-growing business as among the largest home-based post-acute care businesses within the...
View ArticleIndiana Enacts 6-Month HCBS Waiver Provider Enrollment Moratorium
Indiana has instituted a six-month provider certification and enrollment moratorium on some home- and community-based services waiver providers after gaining approval from the Centers for Medicare...
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Political Fight Over Medicaid Deferrals Heightens Risks For Home Care
This article is a part of your HHCN+ Membership When I started covering home-based care, I did not anticipate that the industry would become a flashpoint in partisan politics, beyond familiar debates...
View Article[Updated] HHS Defers Over $1B In Medicaid Payments, Including For Home-Based...
On Tuesday, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) announced that the agencies deferred over $1 billion in Medicaid payments...
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MedPAC Flags California, Los Angeles As Drivers Of Home Health Agency Growth
Medicare-certified home health agency supply continued to grow in 2024, but much of that expansion was concentrated in California — particularly Los Angeles County, an area previously identified by...
View ArticlePPL Seeks To Dismiss NY CDPAP Case
Public Partnerships LLC (PPL) is seeking dismissal of the Department of Justice’s (DOJ) lawsuit over its administration of New York’s Consumer Directed Personal Assistant Program (CDPAP), calling the...
View ArticleWhy Joint Ventures May Outpace M&A During the CMS Home Health Enrollment...
The Centers for Medicare & Medicaid Services’ (CMS) six-month moratorium on new Medicare home health enrollments limits one pathway for providers to scale, but operators can still expand...
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‘Sorely Needed:’ Home Health Leaders Weigh Relief, Lingering Risks In...
This article is a part of your HHCN+ Membership The Centers for Medicare & Medicaid Services’ (CMS) proposed home health payment rule for CY2027 is a mixed bag for providers and industry insiders,...
View ArticlePPL Reaches Proposed $162M Settlement With NY CDPAP Caregivers
A federal judge has preliminarily approved a $162 million class action settlement to approximately 200,000 home care workers over alleged payroll and benefits violations after New York transitioned...
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CMS Elicits Tempered Payment Optimism, Stokes Fraud Fears With Proposed...
This article is a part of your HHCN+ Membership The 2027 Medicare home health proposed payment rule dropped yesterday, and it was a surprising one. The home health industry has become accustomed to...
View ArticleWhy Midterms, CMS Precedent Signal Extension To Home Health Enrollment...
Home health leaders and stakeholders have largely responded to the Centers for Medicare and Medicaid Services’ (CMS) moratorium on home health enrollment with concerns about a broad-brush approach to...
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Medicare Pre-Claim Review Saved $1.2B In Illinois, Had Little Impact Elsewhere
The Centers for Medicare and Medicaid (CMS) has experimented with pre-claim review processes — and new research suggests that this Medicare program can be highly effective, but only in certain states....
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