Tagged Medicare

Podcast: KHN’s ‘What The Health?’ You Have Questions, We Have Answers

This week, KHN’s “What the Health?” panelists answered questions submitted by listeners.

Among the topics covered were what might happen to parts of the Affordable Care Act if a lawsuit now working its way through the courts succeeds in declaring the health law unconstitutional, and how Medicare and Medicaid deal with surprise medical bills from out-of-network providers.

This week’s panelists are Julie Rovner of Kaiser Health News, Jennifer Haberkorn of the Los Angeles Times, Joanne Kenen of Politico and Kimberly Leonard of the Washington Examiner.

The panel addressed questions including the following:

  • What would happen to the Medicare Part D “doughnut hole” if the entire ACA is struck down, and would newer bills, such as the Bipartisan Budget Act, which helped close the coverage gap for brand-name drugs one year early, prevent this feature of the ACA from being eliminated?
  • Will the Health Insurance Portability and Accountability Act (HIPAA) of 1996 remain if the ACA is completely overturned?
  • Since surprise medical bills aren’t allowed in Medicare and Medicaid, what happens when an anesthesiologist or contract emergency room doctor who doesn’t accept Medicare or Medicaid treats an enrolled patient? Do they take a lower rate? Does the hospital make up the difference? Why can’t this be applied to all out-of-network arrangements?
  • Statistics show that approximately 5% to 10% of the population accounts for about 50% of total health care spending. Who makes up this population? Are there any reasonable proposals to address the health of this population and perhaps reduce spending while improving outcomes?

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: Kaiser Health News’ “Lethal Plans: When Seniors Turn To Suicide In Long-Term Care,” by Melissa Bailey and JoNel Aleccia

Jennifer Haberkorn: The New York Times’ “Insurers Want to Know How Many Steps You Took Today,” by Sarah Jeong

Joanne Kenen: Vox.com’s “Walmart’s $25 Insulin Can’t Fix the Diabetes Drug Price Crisis,” by Julia Belluz

Kimberly Leonard: The [Columbia, S.C.] State’s “SC Inmate’s Baby Died in Toilet: Lawsuits Allege Rampant Medical Neglect in Prisons,” by Emily Bohatch

And, The Atlanta Journal-Constitution’s “For Some in Ga. Prisons and Jails, Diabetes Has Meant a Death Sentence,” by Danny Robbins

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher, Google Play or Spotify.

Podcast: KHN’s ‘What The Health?’ You Have Questions, We Have Answers

This week, KHN’s “What the Health?” panelists answered questions submitted by listeners.

Among the topics covered were what might happen to parts of the Affordable Care Act if a lawsuit now working its way through the courts succeeds in declaring the health law unconstitutional, and how Medicare and Medicaid deal with surprise medical bills from out-of-network providers.

This week’s panelists are Julie Rovner of Kaiser Health News, Jennifer Haberkorn of the Los Angeles Times, Joanne Kenen of Politico and Kimberly Leonard of the Washington Examiner.

The panel addressed questions including the following:

  • What would happen to the Medicare Part D “doughnut hole” if the entire ACA is struck down, and would newer bills, such as the Bipartisan Budget Act, which helped close the coverage gap for brand-name drugs one year early, prevent this feature of the ACA from being eliminated?
  • Will the Health Insurance Portability and Accountability Act (HIPAA) of 1996 remain if the ACA is completely overturned?
  • Since surprise medical bills aren’t allowed in Medicare and Medicaid, what happens when an anesthesiologist or contract emergency room doctor who doesn’t accept Medicare or Medicaid treats an enrolled patient? Do they take a lower rate? Does the hospital make up the difference? Why can’t this be applied to all out-of-network arrangements?
  • Statistics show that approximately 5% to 10% of the population accounts for about 50% of total health care spending. Who makes up this population? Are there any reasonable proposals to address the health of this population and perhaps reduce spending while improving outcomes?

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: Kaiser Health News’ “Lethal Plans: When Seniors Turn To Suicide In Long-Term Care,” by Melissa Bailey and JoNel Aleccia

Jennifer Haberkorn: The New York Times’ “Insurers Want to Know How Many Steps You Took Today,” by Sarah Jeong

Joanne Kenen: Vox.com’s “Walmart’s $25 Insulin Can’t Fix the Diabetes Drug Price Crisis,” by Julia Belluz

Kimberly Leonard: The [Columbia, S.C.] State’s “SC Inmate’s Baby Died in Toilet: Lawsuits Allege Rampant Medical Neglect in Prisons,” by Emily Bohatch

And, The Atlanta Journal-Constitution’s “For Some in Ga. Prisons and Jails, Diabetes Has Meant a Death Sentence,” by Danny Robbins

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher, Google Play or Spotify.

Changes To CMS Readmission Penalties Appear Effective In Addressing Unique Challenges Of Rural, Teaching Hospitals

The changes were made to address complaints from hospitals—safety-net hospitals in particular—that they are unfairly penalized in the readmissions program because of their complex patient case mix. For rural hospitals, their average penalties are estimated to decline from $55,268 to $53,633; while average penalties for teaching hospitals will drop from $287,268 to $283,461. Other news from CMS looks at accountable care organizations and primary care accounts.

Changes To CMS Readmission Penalties Appear Effective In Addressing Unique Challenges Of Rural, Teaching Hospitals

The changes were made to address complaints from hospitals—safety-net hospitals in particular—that they are unfairly penalized in the readmissions program because of their complex patient case mix. For rural hospitals, their average penalties are estimated to decline from $55,268 to $53,633; while average penalties for teaching hospitals will drop from $287,268 to $283,461. Other news from CMS looks at accountable care organizations and primary care accounts.

Town Hall Audience Erupts In Cheers When Asked About Support For Sanders’ ‘Medicare For All’ Plan

The slice of public opinion at the town hall for 2020 hopeful Sen. Bernie Sanders (I-Vt.) reflects broader polling that shows support for a system that guarantees universal coverage. However, when details about paying for the plan are revealed, that support has, in the past, dropped.

Calif.-Based Sutter Health Agrees To $30M Settlement Over Allegations Of Submitting Inflated Diagnosis Codes To CMS

The Department of Justice alleged that Sutter and its affiliates had submitted diagnosis codes that inflated the risk scores for certain beneficiaries in their care. “With some one-third of people in Medicare now enrolled in managed care…plans, large health care systems such as Sutter can expect a thorough investigation of claimed enrollees’ health status,” said Steven J. Ryan, special agent in charge with the Office of Inspector General for the U.S. Department of Health and Human Services.

Calif.-Based Sutter Health Agrees To $30M Settlement Over Allegations Of Submitting Inflated Diagnosis Codes To CMS

The Department of Justice alleges that Sutter and its affiliates submitted diagnosis codes that inflated the risk scores for certain beneficiaries in their care. “With some one-third of people in Medicare now enrolled in managed care…plans, large health care systems such as Sutter can expect a thorough investigation of claimed enrollees’ health status,” said Steven J. Ryan, special agent in charge with the Office of Inspector General for the U.S. Department of Health and Human Services.

Watch: Sanders Re-Ups ‘Medicare-For-All,’ Gets More Mileage On Campaign Trail

KHN chief Washington correspondent Julie Rovner appeared on two CNN programs to help explain what’s known and what’s still to be figured out about the “Medicare-for-all” plan Sen. Bernie Sanders (I-Vt.) reintroduced this week in the Senate. The plan by Sanders, who is among the front-runners in the Democratic presidential primary race, has drawn a lot of attention on the campaign trail and Capitol Hill.

Watch CNN’s “New Day” with Alisyn Camerota and John Berman.

Watch “CNN Newsroom” with Brooke Baldwin.

Podcast: KHN’s ‘What The Health’: Still More ‘Medicare-For-All’

Vermont Sen. Bernie Sanders, a presidential candidate, unveiled the 2019 version of his “Medicare-for-all” bill this week. But even more than two decades after first proposing a single-payer plan for the U.S., Sanders still has not proposed a way to finance such a major undertaking.

Congress continued to pursue its examination of high prescription drug prices this week by calling to testify both insulin makers and the drug “middlemen” known as pharmacy benefit managers.

And Idaho is following Utah in trying to scale back an expansion of Medicaid under the Affordable Care Act approved by voters last November.

This week’s panelists are Julie Rovner of Kaiser Health News, Sarah Kliff of Vox.com, Margot Sanger-Katz of The New York Times and Paige Winfield Cunningham of The Washington Post.

Also, Rovner interviews Ceci Connolly, president and CEO of the Alliance of Community Health Plans.

Among the takeaways from this week’s podcast:

  • “Medicare-for-all” was in the spotlight again this week with the release of Sanders’ bill, which is co-sponsored by four of the five other Senate Democrats running for president. Still, neither Sanders nor any other candidates — or their proposals — focus on how to pay for it. Experts differ on how much expanding Medicare would cost. But, whether it’s moving around money already being spent or raising new taxes, expanding Medicare to more people would result in winners and losers, a key political factor going forward.
  • Both parties face internal divisions over health care, revolving around whether to create something new or stick with the status quo. Within the GOP, the split is between Republicans who point to years of unsuccessful efforts to repeal and maybe replace the ACA and want to move on to other things, and others — including some in the White House — who are continuing the push. Democrats’ division is between those who back House Speaker Nancy Pelosi’s call to strengthen and improve the ACA and those who back various efforts to create a Medicare-for-all system.
  • The GOP is playing both offense and defense on the ACA. Leaders say they want to be the party of health care and protect people with preexisting medical conditions, even as the Justice Department is officially backing a court ruling in Texas that would invalidate the entire law, including those protections.
  • There was lots of talk but little action on drug prices at hearings before Congress. Lawmakers heard from drug companies and pharmacy benefit managers, but are no closer to answering the question about what to do about high drug prices. While there may be incremental changes that can be adopted, few expect legislation that would fundamentally change business practices, intellectual property rights or the ability for Medicare to negotiate drug prices.
  • Action in the Utah and Idaho legislatures around Medicaid expansion show that even successful ballot initiatives to expand the program can be changed by lawmakers in ways voters may not have expected. In both state capitols, elected officials reduced the number of people eligible for expansion below what voters approved.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: The New York Times’ “Would ‘Medicare for All’ Save Billions or Cost Billions?” By Josh Katz, Kevin Quealy and Margot Sanger-Katz

Sarah Kliff: Politico’s “Public Option Hits a Wall in Blue States,” by Rachana Pradhan and Dan Goldberg

Margot Sanger-Katz: Politico’s “Obamacare Fight Obscures America’s Real Health Care Crisis: Money,” by Joanne Kenen

Paige Winfield Cunningham: STAT News’ “Amazon Alexa Is Now HIPAA-Compliant. Tech Giant Says Health Data Can Now Be Accessed Securely,” by Casey Ross

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Making Smarter Decisions About Where To Recover After Hospitalization

Every year, nearly 2 million people on Medicare — most of them older adults — go to a skilled nursing facility to recover after a hospitalization. But choosing the facility can be daunting, according to an emerging body of research.

Typically, a nurse or a social worker hands out a list of facilities a day or two — sometimes hours — before a patient is due to leave. The list generally lacks such essential information as the services offered or how the facilities perform on various measures of care quality.

Families scramble to make calls and, if they can find the time, visit a few places. Usually they’re not sure what the plan of care is (what will recovery entail? how long will that take?) or what to expect (will nurses and doctors be readily available? how much therapy will there be?).

If asked for a recommendation, hospital staffers typically refuse, citing government regulations that prohibit hospitals from steering patients to particular facilities and that guarantee patients free choice of medical providers. (This is true only for older adults with traditional Medicare; private Medicare Advantage plans can direct members to providers in their networks.)

“The reality is that we leave patients and families without good guidance at a really vulnerable point in their care trajectory,” said Dr. Robert Burke, an assistant professor of medicine at the University of Pennsylvania’s Perelman School of Medicine.

Amid stress and confusion, older adults and their families frequently make less than optimal choices. According to a 2018 report from the Medicare Payment Advisory Commission (MedPAC), an independent agency that advises Congress on Medicare, nearly 84% of Medicare beneficiaries who go to a skilled nursing facility (SNF) after a hospital stay could have selected a higher-rated provider within a 15-mile radius. On average, MedPAC noted, hospitals refer patients needing short-term rehabilitation to 34 facilities. (Fewer options are available in rural areas.)

Where older adults go is important “because the quality of care varies widely among providers,” MedPAC’s report notes, and this affects how fully people recover from surgeries or illnesses, whether they experience complications such as infections or medication mix-ups, and whether they end up going home or to a nursing home for long-term care, among other factors.

A recently completed series of reports from the United Hospital Fund in New York City highlights how poorly older adults are served during this decision-making process. In focus groups, families described feeling excluded from decisions about post-hospital care and reported that websites such as Medicare’s Nursing Home Compare, which rates facilities by quality of care and other performance criteria, weren’t recommended, easy to use or especially helpful.

What do older adults and family members need to know before selecting a rehab facility after a hospital stay? Recent academic research, policy reports and interviews with experts elucidate several themes.

The Basics

Who needs post-hospital care in a rehabilitation center? Surprisingly, there are no definitive guidelines for physicians or discharge planners. But older adults who have difficulty walking or taking care of themselves, have complex medical conditions and complicated medication regimens, need close monitoring or don’t have caregiver support are often considered candidates for this kind of care, according to Kathryn Bowles, professor of nursing at the University of Pennsylvania School of Nursing.

Medicare will pay for short-term rehabilitation at SNFs under two conditions: (1) if an older adult has had an inpatient hospital stay of at least three days; and (2) if an older adult needs physical, occupational or speech/language therapy at least five days a week or skilled nursing care seven days a week.

Be sure to check your status, because not all the time you spend in a hospital counts as an inpatient stay; sometimes, patients are classified as being in “observation care,” which doesn’t count toward this three-day requirement.

Traditional Medicare pays the full cost of a semiprivate room and therapy at a skilled nursing facility for up to 20 days. Between 21 and 100 days, patients pay a coinsurance rate of $170.50 per day. After 100 days, a patient becomes responsible for the full daily charge — an average $400 a day. Private Medicare Advantage plans may have different cost-sharing requirements.

Nationally, the average stay for rehabilitation is about 25 days, according to a recent editorial on choosing post-hospital care in the Journal of the American Geriatrics Society.

Quality Varies Widely

In its 2018 report, MedPAC documented large variations in the quality of care provided by SNFs. Notably, facilities with the worst performance were twice as likely to readmit patients to the hospital as those with the best performance. (Readmissions put patients at risk of a host of complications. This measure applied only to readmissions deemed potentially avoidable.) Patients at the best-performing facilities were much more likely to be discharged back home and to regain the ability to move around than those at the worst-performing facilities.

In April, for the first time, Medicare’s Nursing Home Compare website is separating out performance measures for short-term stays in SNFs, for people who are recovering after a hospitalization, and long-term stays, for people with severe, chronic, debilitating conditions.

Seven measures for short-term stays will be included: the portion of patients who experience an improvement in their functioning (such as the ability to walk), return home to the community, are readmitted to the hospital, visit the emergency room, get new prescriptions for antipsychotic medications, have pain well controlled, and are adequately treated for bedsores, according to Dr. David Gifford, senior vice president for quality and regulatory affairs at the American Health Care Association, which represents nursing homes and assisted living centers. There will also be a separate “star rating” for short-term stays — an overall indicator of quality.

Questions To Ask

Before making a decision on post-hospital care, older adults and family members should address the following issues:

Your post-hospital needs. Bowles, who has studied what kind of information patients and families find valuable, suggests people ask: What are my needs going to be during the post-hospital period? What kind of help will be needed, and for approximately how long?

Dr. Lena Chen, an associate professor of internal medicine at the University of Michigan who has published research examining wide variations in spending on post-acute care after a hospitalization, suggests asking: What is my anticipated recovery, and what do you think the most difficult parts of it might be?

What the SNF provides. Bowles also suggests people ask why the SNF is being recommended instead of home health care. How will the SNF meet my needs, specifically? What kind of medical care and therapy will I get there? From whom and how often?

Carol Levine, who directs the United Hospital Fund’s Families and Health Care Project, suggests that patients and families seek out details about facilities. Is a doctor readily available? (New research suggests 10% of patients in skilled nursing facilities are never seen by a physician, nurse practitioner or physician assistant.) What kind of equipment and specialized services are on-site? Can the facility accommodate people with cognitive issues or who need dialysis, for instance?

Getting information early. Dr. Vincent Mor, professor of health services, policy and practice at Brown University’s School of Public Health, said patients and families should insist on seeing a discharge planner soon after entering the hospital and start the planning process early. When a planner comes by, “say, ‘I don’t care about choices: Tell me, what do you think will be best for me?’ Be insistent,” he advised.

Burke warns that doctors don’t typically know which SNF is likely to be the best fit for a particular patient — a topic he has written about. He suggests that older adults or their families insist they be given time to contact facilities if they feel rushed. While there’s considerable pressure to discharge patients quickly, there’s also a requirement that hospital discharges be safe, Burke noted. “If we’re waiting for a family to tell us which facility they want a patient to go to, we can’t make a referral or discharge the patient,” he said.

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

Trump May Delay Change That Could Cause Medicare Drug Premiums To Jump 19% Until After 2020 Election

The monthly cost to individual seniors from the Trump administration’s proposed change could rise by about $6. While that may not a large amount, it would not go unnoticed by seniors on fixed incomes. Meanwhile, House Speaker Nancy Pelosi is urging the president to sign a bill to allow Medicare to negotiate drug prices.

Economists Weigh In On True Cost Of ‘Medicare For All.’ Bottom Line: It Would Be Expensive.

Sen. Bernie Sanders (I-Vt.), a 2020 hopeful at the front of a crowded pack, is set to unveil an updated version of his “Medicare for All” legislation, a plan that has gained momentum with progressive Democrats. It’s difficult to put an actual price tag on one of the largest proposed domestic policy changes in a generation, but economists try provide an estimate. In the end, patients would probably pay less, and the government would pay a whole lot more.

Consumers Rejected Drug Plan That Mirrors Trump Administration Proposal

Unraveling how much of a prescription drug price gets swallowed by “middlemen” is at the forefront of Tuesday’s drug price hearing in the Senate. One thing bound to come up: rebates.

Both major political parties have shown interest in remedying high drug prices, and drugmakers have bemoaned how rebates to middlemen keep them from reaping every dollar associated with those price tags.

Pharmacy giant CVS Health criticized the Trump administration’s proposal to end these post-transaction discounts as they apply to Medicare. Yet, in January the company rolled out a Medicare drug plan that experts say is similar “in spirit” to the administration’s proposal.

The CVS Caremark plan wasn’t popular with customers, and CVS Health, which owns CVS Caremark, was quick to point this out as evidence that consumers prefer the current rebate system.

“We had a very, I would say, small number of seniors enroll in that program,” Larry Merlo, CVS Health’s CEO said on a February earnings call with investors. “And we think one of the barriers to that was the increase that we saw in the monthly premium.”

The CVS plan’s premium was $80 a month, which is about double the average Medicare Part D monthly charge. But since it is designed to pass on a portion of rebates directly to patients at the pharmacy counter, certain patients would wind up with smaller out-of-pocket costs than they previously paid.

“Even very well-informed consumers would not necessarily understand that a higher premium plan in this case means that they’re incurring smaller amounts at the point of sale,” said Rachel Sachs, an associate law professor at Washington University in St. Louis who specializes in health care.

So why did only 25,000 people sign up for the plan, called SilverScript Allure? Either consumers didn’t want the plan or perhaps they just didn’t understand it?

We’ll break it down for you.

Untangling Jargon: The Way Things Are And How They Could Change

A pharmacy benefit manager, or PBM, handles drug claims for health insurance companies. The big ones are Express Scripts, CVS Caremark and OptumRx. Every time you fill a prescription and use your drug plan, your PBM is involved in paying the claim and determining how much money you owe the cashier.

A rebate is a discount the PBM negotiates with a drug manufacturer off the price the drugmaker sets, which is called a list price. Rebates are not made public, and they typically don’t get passed on to the patient at the pharmacy counter in the form of a lower copayment, experts say.

When the drugmaker eventually pays the rebate back to the PBM, the PBM often uses this money to lower premiums, which are the monthly fees that Medicare Part D plans charge beneficiaries. They differ for each drug plan.

In a way, patients taking drugs with high list prices and big rebates wind up subsidizing other patients’ premiums, said Erin Trish, the associate director of the University of Southern California Schaeffer Center for Health Policy and Economics. Premiums on average haven’t substantially increased in more than a decade, but it may be “unfair” to the patients paying higher prices for drugs at the pharmacy counter.

“Some may argue, ‘They’re sicker… Maybe they should [pay more],’” Trish said. “Look. We decided everyone should pay the same premium in this market. [Rebates] shouldn’t be a roundabout way to make a subset of beneficiaries pay more.”

That could all change under a new Trump administration proposal that would ban rebates as they exist today. The negotiated discounts would be applied at the pharmacy counter, meaning discounts would be passed on to patients as out-of-pocket costs that are calculated based on the discounted price, not the higher list price.

For patients taking drugs with high list prices and large rebates, like insulin, it could mean noticeable savings, Sachs said. For patients taking drugs without big rebates, like generics or brand-name drugs without other branded competition, they’re not likely to see much change at the pharmacy counter.

Everyone, however, will see premiums go up. It’s unclear yet how much, but Trish said the SilverScript Allure plan CVS Caremark is offering isn’t necessarily the best indicator. Consultants hired by the Department of Health and Human Services estimated premiums will go up $3.20 to $5.64 per month if the rule takes effect in 2020. The average Medicare Part D premium for 2019 was $41.21, according to the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

So Why Didn’t Patients Want The CVS Caremark Plan?

It’s not clear how well seniors shopping for drug plans understood the SilverScript Allure plan, among their many options. They could see it had a high premium, but no deductible. They might not have realized it required smaller payments on drugs at the pharmacy counter.

Research shows that the premium is the most important factor seniors consider when choosing a plan, Sachs said.

On top of that, people are unlikely to leave their current plans even if there’s a better one available.

What’s more, we don’t know how well CVS Caremark marketed the plan to seniors who would benefit. They wouldn’t tell us, despite multiple calls and emails.

OptumRx, a competing PBM, started offering customers similar discounts at the pharmacy counter — but for people with commercial insurance, not Medicare or Medicaid. Unlike CVS Caremark, it has a web page with basic language, like “point of sale discounts mean lower costs,” and a link to request more information about switching. OptumRx did not respond to a request for comment.

PBMs: Helping Or Hurting?

Rebates for individual plans and drugs are confidential, but in Medicare Part D, they’ve increased on average from 9.6% of total spending in 2007 to 19.9% in 2016, according to annual reports to the Medicare boards of trustees.

So it’s perhaps unsurprising the brand-name drug trade group, the Pharmaceutical Research and Manufacturers of America, said it “applaud[s]” the proposal to overhaul the rebate system. PhRMA says it pushes them to raise prices in order to offer larger rebates, because drugs with larger rebates often get preferential treatment by PBMs.

Still, PBMs offer the benefit of batting down net prices (the price after rebate), and keeping down drug spending overall.

There are multiple estimates on how much the rebate proposal would cost the Centers for Medicare & Medicaid if it took effect, and they indicate that unless there are other changes to Medicare Part D, it would likely cost more money than the current system, Sachs said.

“It is startling to see the administration moving forward so rapidly with this proposal without a better understanding of how different actors might respond,” she said. As a result, there’s a “huge amount of uncertainty” over how this could all play out.

Florida Health Care Businessman Charged In $1B Medicare Fraud Scheme, One Of Biggest In History

Federal prosecutors say Philip Esformes, a Miami Beach resident, was the mastermind of a scheme paying bribes and kickbacks to doctors to refer patients to his nursing home network from 2009 to 2016, as well as paying regulators to inform him when patients complained and when there would be inspections. News on Medicare fraud comes from Illinois, as well.

Florida Health Care Businessman Charged In $1B Medicare Fraud Scheme, One Of Biggest In History

Federal prosecutors say Philip Esformes, a Miami Beach resident, was the mastermind of a scheme paying bribes and kickbacks to doctors to refer patients to his nursing home network from 2009 to 2016, as well as paying regulators to inform him when patients complained and when there would be inspections. News on Medicare fraud comes from Illinois, as well.