Washington, D.C. — The federal government is taking an aggressive new stance on Medicaid fraud, and the approach is unlike anything states have seen before. The Centers for Medicare and Medicaid Services has begun deferring and withholding hundreds of millions of dollars in federal Medicaid payments — not after fraud is confirmed, but while it’s still being investigated. That shift carries real consequences for long-term care providers, whose Medicaid revenue depends on states receiving their full federal match without interruption. A New Playbook for Federal Enforcement For decades, CMS handled suspected Medicaid fraud through a process called a disallowance —…
Author: Mordy Y
Indianapolis, Indiana — Indiana just became one of the first states to pull a specific class of nursing home residents out of the Medicaid managed care system entirely. Gov. Mike Braun signed House Bill 1277 into law last week, setting in motion a sweeping change to how the state pays for long-term nursing care — and it’s a shift that could reshape how Indiana’s facilities operate starting in 2027. At the center of the law is a single, targeted provision: beginning July 1, 2027, any Medicaid recipient who has been living in a nursing facility for 100 consecutive days or…
Virginia is about to make it much harder to flip a nursing home. Richmond, Virginia — A new law heading to the Governor’s desk would end a common practice that critics say lets unqualified buyers take over nursing homes with almost no accountability. House Bill 717 passed the Virginia General Assembly without a single dissenting vote — and if signed, it will require any new operator to get a state license before taking control of a facility. Closing the Interim Management Loophole Under current state law, a buyer can assume control of a nursing home before formal licensure through an…
A new peer-reviewed study has found that nursing homes are doing something assisted living communities often aren’t: keeping residents vaccinated — and out of the hospital. The research, published in February 2026, compared vaccination program participation across seven vaccine-preventable illnesses in nursing homes and assisted living communities across the United States. The findings were clear: nursing homes were significantly more likely to run formal vaccination programs for those conditions, and their residents were hospitalized for those illnesses at lower rates as a result. Researchers used logistic regression models to understand which organizational factors drove the gap, looking at variables like…
WASHINGTON, D.C. — Aetna Inc. has agreed to pay $117.7 million to settle federal allegations that the national insurer manipulated Medicare Advantage billing to pocket millions in inflated payments — a scheme that put senior care funding directly at risk. The U.S. Department of Justice announced the False Claims Act settlement this week, alleging that Aetna submitted inaccurate patient diagnosis codes to the Centers for Medicare and Medicaid Services in order to overstate how sick its Medicare Advantage enrollees were. Under the MA program, sicker patients mean higher payments. The government says Aetna played that system. How the Scheme Worked…
New York, New York — A major new report from researchers at New York University paints a troubling picture of what happens when private equity firms take the wheel in nursing home care: higher death rates, fewer nurses, and a dramatically elevated risk of bankruptcy. The study, released Tuesday by researchers at NYU Stern’s Center for Business and Human Rights, found that private equity-owned nursing homes are linked to an 11% higher mortality rate compared to non-PE facilities. Residents at those homes also face 25% higher rates of in-hospital complications and are 50% more likely to be given antipsychotic medications…
Respiratory therapy has quietly become one of the most financially consequential services a skilled nursing facility can offer — and regulators are starting to take notice. Industry reports now estimate that as many as half of all nursing home patients could potentially benefit from respiratory services, a figure that reflects both the clinical realities of an aging population and the significant reimbursement incentives baked into the Patient Driven Payment Model (PDPM). Under PDPM, respiratory conditions boost a resident’s payment classification in multiple categories, including nursing and non-therapy ancillaries — making it one of the higher-revenue service lines available to providers.…
After two years of uncertainty, nursing home providers may soon get clarity on proposed changes to Medicare’s non-therapy ancillary (NTA) payment system — a move that could significantly affect reimbursement for facilities caring for medically complex residents. The NTA system is part of the Patient Driven Payment Model (PDPM), which replaced the RUG-IV payment structure in 2019. Under PDPM, NTA codes provide additional reimbursement for residents with costly conditions such as HIV/AIDS, ventilator dependency, chronic obstructive pulmonary disease (COPD), and certain wound infections. Federal regulators first proposed revising the NTA point system in the fiscal year (FY) 2025 Medicare payment…
Washington, District of Columbia — Federal regulators are taking a fresh look at one of nursing homes’ most contentious quality measures, reopening a fight over antipsychotic use that providers say has long punished clinically appropriate care along with the bad actors. The Centers for Medicare & Medicaid Services said it is reviewing the antipsychotic quality measure with the goal of supporting clinically indicated use while still discouraging inappropriate prescribing. The agency said it remains committed to evidence-based quality measures and transparency for residents and families, but it did not say when any changes might be made. The review matters because the…
Washington, District of Columbia — A new study arguing that state nursing home staffing mandates did not trigger closures or broad financial harm is drawing sharp criticism from industry voices who say the analysis overlooks the real tradeoffs operators face. According to industry reports, the study found no clear evidence that state-level staffing minimums caused widespread facility shutdowns or severe financial damage. That conclusion quickly ran into resistance from providers and advocates who contend the picture is more complicated, especially for facilities already operating with weak margins, limited labor pools and growing regulatory demands. The dispute matters because staffing policy…
