The insurance and health care company UnitedHealth Group (NYSE: UNH) may be under federal criminal investigation for alleged Medicare fraud. The U.S. Justice Department has not released the specific allegations against the company. However, they are reportedly related to UnitedHealth Group’s business practices within its Medicare Advantage plans, according to the Wall Street Journal, which […]
An evolving regulatory landscape may be complicating hospices’ ability to effectively implement and use artificial intelligence technology. The top legal considerations involving AI center around protecting patient privacy and ensuring transparent innovation. Hospices have leveraged AI to better predict patient trajectories, ease employees’ administrative burden, boost retention, and improve compliance and operational efficiency, among other […]
The Wisconsin State Assembly has approved a bill requiring the state’s Department of Health Services (DHS) to create a statewide palliative care council. A group of 22 palliative clinical professionals, patients and family members would comprise the council to help address care delivery issues and raise awareness in the field. The council would also include […]
The Center for Medicare and Medicaid Innovation (CMMI) will implement a new, three-pronged strategic direction aimed at improving access and outcomes while reducing health care costs. More seriously ill individuals are living longer with multiple comorbidities, a trend that has increasingly overburdened and financially strained the health care system and families across the country, according […]
The U.S. Department of Justice (DOJ) has rejected the sale of Amedisys’ (Nasdaq: AMED) home health and hospice assets to BrightSpring Health Services Inc. (Nasdaq: BTSG) and The Pennant Group (Nasdaq: PNTG) as a remedy to an ongoing lawsuit. Amedisys earlier this month announced the divestiture of a number of its home health and hospice […]
A tax bill currently before Congress could lead to Medicaid cuts that would inhibit access to home- and community-based services (HCBS). The bill, which promises sweeping tax and spending cuts, currently is undergoing a reconciliation process. The amount of tax cuts could reach $4.5 trillion, with spending cuts in the area of $4.5 billion, with […]
Petros Fichidzhyan, 44, of Granada Hills, California, has been sentenced to 12 years in prison and three years of supervised release for his role in a mulit-year scheme to defraud Medicare of more than $17 million. Fichidzhyan committed the fraud through “sham” hospice companies and a home health company that he owned, according to the […]
The U.S. Centers for Medicare & Medicaid Services’ (CMS) period of enhanced oversight for hospices in California, Nevada, Arizona and Texas has resulted in nearly $456,000 in claims denials to date. Cumulatively, the Medicare Administrative Contractor (MAC) company Palmetto found 330 claims with edit effectiveness through a pre-payment review, 99 of which were denied. This […]
The U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) is readying to unveil a new report that will unveil common billing trends among potentially fraudulent newly licensed hospices. The report, “Trends, Patterns, and Key Comparisons Related to New Medicare Hospice Provider Enrollments May Indicate the Need for Further Oversight” is […]
A federal jury has convicted Eduardo Lopez, a former Nevada hospice executive, for his involvement in a wage-fixing conspiracy, as well as five counts of wire fraud. Potential sentencing includes several years of imprisonment and millions in criminal fees. Lopez in 2023 was charged with agreeing to suppress and eliminate competition for home health and […]
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