Trump Nominates Dr. Mehmet Oz as CMS Administrator

President-Elect Donald Trump has tapped Dr. Mehmet Oz to become administrator of the U.S. Centers for Medicare & Medicaid Services (CMS). Oz rose to fame in the early 2000s as a talk show host and a frequent guest on The Oprah Winfrey Show. In 2022, he ran for the U.S. Senate in Pennsylvania as a […]

Medicare Made $190M in Improper Hospice Payments to Hospitals

Medicare made an estimated $190 million in improper payments to acute-care hospitals for outpatient hospice services between 2017 and 2021. An audit by the U.S. Department of Health and Human Services Office of the Inspector General (OIG) set out to determine whether Medicare payments to acute-care hospitals for outpatient services provided to hospice enrollees complied […]

Hospices Leaders: ‘Vigilant’ Compliance Pivotal in MAC Auditing Climate

The auditing environment has heated up in the hospice industry, with inconsistencies reportedly proliferating among the various types of regulatory enforcement activity — particularly those performed by Medicare Administrative Contractors (MACs). The issue has some hospice providers delving deeper into a range of compliance strategies. Differences exist in the scope of data being reviewed by […]

Inside the Justice Department’s Amedisys-Optum Lawsuit

The rationale behind the U.S. Justice Department’s lawsuit against Optum and Amedisys (Nasdaq: AMED) is multi-faceted, citing potential adverse impacts on competition, home-based care workers and payers. Optum, a subsidiary of UnitedHealth Group (NYSE: UNH) in June 2023 penned its agreement to acquire Amedisys in an all-cash transaction of $101 per share, or about $3.3 […]

CMS Ramps Up Efforts to Root Out ‘Door Knocker’ Hospice Schemes

The U.S. Centers for Medicare & Medicaid Services (CMS) recently elaborated on its plans to expand public education campaigns designed to help protect hospice beneficiaries from fraudulent actors in the space. Program integrity concerns have heated up in the hospice industry. Swarms of new hospices have emerged in certain regions in recent years, with some […]

[UPDATED] CMS to Surveyors: Keep Eyes Open for Hospice Fraud

The U.S. Centers for Medicare & Medicaid Services (CMS) has issued a memo to accreditation bodies and state agencies advising surveyors to watch out for potential hospice fraud. The memo directs surveyors to refer issues to CMS if they suspect fraudulent activity. These actions were spurred by a rash of fraudulent hospices that have emerged […]

Dr. Andrew Mayo: Hospice Leaders Face ‘Delicate Balance’ in Today’s Regulatory, Workforce Climate

Today’s hospice leaders need to take a wide view into the range of challenges facing their interdisciplinary care teams, according to Dr. Andrew Mayo, chief medical officer at St. Croix Hospice. Mayo joined St. Croix Hospice in 2014 as an associate medical director. The Minnesota-headquartered hospice provider is a portfolio company of the private equity […]

[UPDATED] Justice Department Reportedly Files Lawsuit to Block UnitedHealth Group-Amedisys Deal

The U.S. Department of Justice (DOJ) has filed an antitrust lawsuit to block the acquisition of Amedisys (Nasdaq: AMED) by the UnitedHealth Group (NYSE: UNH) subsidiary Optum. Bloomberg first reported the news. This comes on heels of a “last rights” meeting between the DOJ and the two companies to advocate for sealing the deal. Amedisys […]

Hospices Face ‘Interesting Unknowns’ in Wake of Presidential Election

Hospices are facing a sea of uncertainties in the wake of Wednesday’s presidential election results. Donald Trump has been elected as the 47th president of the United States. The former president received the majority of popular and electoral votes over Vice President Kamala Harris. Hospice and home health providers will need to work with policymakers […]