| The Trump administration’s aggressive crackdown on fraud is ensnaring legitimate health care providers, raising concerns that efforts to root out bad actors are also disrupting care for vulnerable patients. The findings come from a story by The Post’s Isaac Arnsdorf, which looks at several aspects of the Trump administration’s anti-fraud task force led by Vice President JD Vance. Some of the most dire consequences are coming from the crackdown on hospice providers. - The crackdown stems, in part, from a boom in hospice enrollment following pandemic-era flexibilities enacted during the first Trump administration that allowed for new hospice practices to join Medicare with reduced oversight.
- More than 700 hospice agencies have had their Medicare billing privileges revoked since 2023, prior to President Donald Trump’s second term. But the suspensions have been kicked into overdrive amid a broader effort to tamp down on people defrauding the government.
- The Post identified at least 43 suspended hospices that appear to be legitimate and are seeking to have their Medicare funding restored.
Industry groups, providers and regulators repeatedly warned that bad actors were exploiting the system, and some actions were already being taken to thwart them, according to Issac’s report. “The Trump administration is taking a pretty aggressive tactic here, but the downside is you’re often going to catch up legitimate actors because you’re not really taking the time to do your due diligence,” said Hillary Loeffler, vice president of policy and regulatory affairs for the National Alliance for Care at Home, an industry group. Loeffler worked on hospice issues at the Centers for Medicare and Medicaid Services until 2025. INDUSTRY SPOTLIGHT Since larger companies are better equipped to absorb legal costs or survive an interruption in payments, they have been receiving more patients from smaller businesses that CMS had suspended. Stacey Smith, one of the officials advising agency leaders on the policy, lobbied for one of the largest home health and hospice companies, AccentCare, until joining CMS in May. She circulated a research paper throughout the industry last year that recommended CMS “act decisively,” with steps such as “suspend payments without advance notice.” Why it matters: The sweeping enforcement actions have risked disrupting end-of-life care for some patients, while forcing certain legitimate providers out of business and concentrating more patients among large hospice chains. Issac also reports that the suspensions have caused some patients to lose their care without being transferred to a new facility. - One Los Angeles-area hospice owner told The Post his agency maintained the industry’s most rigorous accreditation, had never received a formal complaint and cared for only a few dozen patients at a time.
- But, after he began to accept patients from hospice agencies that had been shuttered, the CMS suspended its payments and later denied a 700-page appeal, forcing the owner to transfer patients and close the business.
“It’s no longer you’re innocent until proven guilty; it became that you’re guilty and now you have to prove your innocence,” said the business owner, who spoke on the condition of anonymity because he has another business that relies on Medicare. ‘FAIRLY GOOD HIT RATE’ - CMS Administrator Mehmet Oz has been touting the administration’s moves to shut off fraudsters’ access to federal cash, and emphasizing that providers who are above board have nothing to fear.
“If we have two dozen hospices that we need to turn back on again, and we’ve shut down 900, that’s a fairly good hit rate,” Oz said last week at a news conference. - Oz’s deputy, Kimberly Brandt, said last month that the agency is working to quickly reverse the suspensions, and she asked on LinkedIn for specific examples to examine. “Our goal is to trust but verify which is unfortunately necessary given the current environment,” Brandt said in a LinkedIn comment.
Some hospice providers that appealed their suspensions have received short denials with little explanation, according to lawyers and one of the CMS responses reviewed by The Post. The law firm Husch Blackwell has submitted more than 40 appeals, none of which CMS reviewed within the 15 days required by law, according to attorney Andrew Brenton. Four of the agencies have succeeded in restoring their funding. What’s next: These California-based suspensions are likely just the beginning. Brenton said Medicare payment suspensions are also starting for hospices in Texas and Georgia. Read more: “Vance’s fraud task force is sweeping up legitimate small businesses.” The Congressional Budget Office is seeking new research on the law meant to protect patients from surprise medical bills called the No Surprises Act. Evidence suggests its effects may differ from CBO’s initial projections. → The 2020 law was expected to lower provider prices and reduce insurance premiums by weakening providers’ leverage. So far, the law appears to have reduced surprise billing and out-of-network claims — and some studies show declines in certain prices. However, CBO says the overall evidence is mixed and is asking for updated research on prices, provider participation in insurance networks, arbitration behavior, and effects on premiums. What to watch: The implementation of the No Surprises Act has ignited a costly set of advocacy and legal battles between providers and insurers. Congress hasn’t shown much interest in revisiting the law — despite complaints from industry heavy hitters — but things could change in the longer term if CBO could show that changes resulted in money saved for the government. (Lawmakers love a budgetary offset.) - Affordable Care Act: Judge Brendan Hurson, of the U.S. District Court for the District of Maryland, will hear arguments in the legal challenge of the Trump administration’s Affordable Care Act rules on July 8.
Earlier this month, a coalition of local governments and advocacy groups asked the court to pause the administration’s changes, including efforts to expand access to catastrophic health plans with bare-bones coverage. The legal advocacy group Democracy Forward filed a lawsuit on the coalition’s behalf to challenge new rules finalized by the Centers for Medicare and Medicaid Services last month, arguing that regulators did not properly consider how the rule would harm millions of consumers who purchase health care coverage on the Affordable Care Act marketplace. → The hearing announcement comes days after Hurson blocked several key provisions of last year’s Obamacare rules, which the Trump administration said is meant to crack down on fraud in the program. The legal challenge was filed by most of the same plaintiffs as the newer suit. The court found that the Department of Health and Human Services exceeded its authority when it imposed a $5 monthly charge on certain subsidized patients and required consumers to pay past-due premiums before obtaining new coverage. The court also struck down some eligibility-verification requirements. But: Hurson upheld changes to the premium-adjustment-percentage methodology, which is a wonky calculation that experts say will increase out-of-pocket limits and affect the calculations for subsidies that some people with Obamacare plans receive. - Vaccine changes: The American Academy of Pediatrics and other public health groups are urging a federal court to reject the Trump administration’s request to expedite an appeal of the pause on several of its key vaccine-related actions.
In a court filing Monday, they argued the administration waited months before seeking expedited review, calling the claimed urgency “contrived.” The dispute stems from Health Secretary Robert F. Kennedy Jr.’s decision to replace all members of the Advisory Committee on Immunization Practices (ACIP) last year, which was paused by a federal judge in Boston in March. On Friday evening, Kennedy wrote in a social media post that the department was filing the request to speed the appeal in order to “restore a functioning ACIP so the vaccine recommendation process can continue.” But Richard H. Hughes IV, a lawyer for the plaintiffs, said in an email that Kennedy has “lawful ways” to restore the influential vaccine panel. “He wants only the unlawful one.” - Pentagon’s 1260H list: WuXi AppTec, which helps pharmaceutical companies with research and manufacturing, sued the Defense Department last week over its designation as a “Chinese military company.” The designation limits the company’s ability to do business with the Pentagon as Washington heightens scrutiny of Chinese firms.
The Defense Department justified the listing by saying that the company — which has five locations in the United States — is “indirectly owned by” the State-owned Assets Supervision and Administration Commission in China, among other allegations. “We want to be absolutely clear: WuXi AppTec is not a Chinese military company — not based on an objective review of the facts, and not under the statutory designation criteria for the Section 1260H list under U.S. law,” the company wrote in a statement before the lawsuit. But also: Being placed on the Pentagon’s 1260H list could also trigger additional limits under the BIOSECURE Act, potentially restricting its work with drugmakers that contract with the federal government. WuXi AppTec has more than 1,200 customers in the United States. “The Kratom Civil War Is Heating Up, and MAHA Has Picked a Side,” Mattha Busby writes at Wired. “Study Linking Vaccines to Autism Retracted,” MedPage Today’s Judy George writes. “In a first, Dexcom’s OTC glucose sensor is cleared for kids,” reports Elise Reuter at MedTech Dive. This newsletter is published by WP Intelligence, The Washington Post’s subscription service for professionals that provides business, policy and thought leaders with actionable insights. WP Intelligence operates independently from the Washington Post newsroom. Learn more about WP Intelligence. | 
