The Truth About Fraud in Home Health

Elyssa Katz – Welcome to Who Cares, the podcast from the National Alliance for Care at Home where policy, people and purpose intersect. Today, we’re taking you behind the scenes of Advocacy Week 2025 and talking about what we have to be hopeful for in 2026.

Elyssa Katz – As you know well, this is 2025 is the first full year of the alliance. And so with that comes many new firsts. And while the legacy organizations that we brought together to form the Alliance have been doing this work for many, many years, this was the first time that our community got to come together. And what I’m referencing is the Alliance’s inaugural Advocacy Week, where we brought together over 240 advocates who met with over 275 different congressional offices.

How are you feeling coming off of Alliance Advocacy Week?

Dr. Steve Landers – Yeah, I’m so proud to have been a part of our first Advocacy Week. This is a big accomplishment for the National Alliance for Care at Home. We were able to get volunteers from all over the country representing home care, hospice, our entire care at home movement in the capital, in the nation’s capital. Right.

We did some training and some coordination work. And then we got out onto Capitol Hill, uh, almost 300 visits to congressional offices talking about issues that matter to all of us, that matter to families across our country. What a wonderful what a what. What a wonderful program.

Elyssa Katz – Absolutely. And it was not my first advocacy week, but I have to say it was my favorite. I felt like the energy was really there. Like this new movement that we have, the full care at home movement. It really amplifies the impact that we can have. We’re not just talking about one silo of health care. And, you know, even the full aggregate of care at home is small potatoes.

When you look at the broader health care system. So it’s so important that we unite and we use that amplification to have a louder voice on Capitol Hill. And I think the size and turnout and the energy and the conversations. You know, the rooms that I was in with congressional leaders, I could tell, like these conversations were going well there.

There isn’t much to not like about care at home.

Dr. Steve Landers – This is, you know, one thing you said that I just want to push back on a little bit is that while the business size or the money in care at home is small potatoes, as you put it? Alyssa, the actual impact, the impact and the relevance of what we do is enormous. It is the number one health policy issue facing an aging nation is how do we support people to be independent, comfortable, live with dignity in spite of serious chronic illness, and do it in a way that’s cost effective for our country.

So it’s definitely a situation where we’re small but mighty. This is a situation where we’ve got to make sure that right beats might in politics. You know, we’re up against all these, well, moneyed interests right in the when we’re talking about health care advocacy, we’ve got, you know, the hospitals and the pharmaceutical companies and and the insurance industry.

And, you know, there’s a lot of important work there. But what we do should, should, should not get overlooked what our members are doing in their communities because it is so high value and so important.

Elyssa Katz – I cannot argue with that. And that is why you’re leading our movement forward. Um, and just for people that weren’t there, we’ll talk about what we actually talked about in the meetings in just a minute. But, you know, we had that first full day of training for folks to make sure they were equipped for these conversations.

We provided some spicy talking points that help them get to the issue quickly, at a level that cares, at a level that can help congressional representatives care about what we’re talking about. And we really emphasize the importance of storytelling because these are the people, when they come to the Hill that have the frontline stories to tell about what the care is actually doing, and that piece of it is honestly the most exciting part of Advocacy Week.

Dr. Steve Landers – Nobody should be afraid. Like, if you’re seeing this right now and you’re thinking, I missed it this year, but maybe I should do something like this in the past, but you get a little bit of a lump in your throat or in your gut, you know. Please know there’s nothing to be afraid of. We will. And our alliance advocacy team and some of our consultants will do a great job making sure everybody is prepared and understands what to expect and help schedule things so that the logistics run smoothly.

And also, you know, some training on the issues. And please know that these representatives, the people that are elected on our behalf, actually, there is nothing more that they welcome than people from their states and districts coming with real authenticity, talking about the work they do. They, you know, there’s plenty of kind of, you know, lobbyists and Gucci shoes, you know, with all the, you know, fancy watches and everything running around Washington.

What there’s not enough is our frontline nurses and aides and therapists and chaplains and people doing that, you know, boots on the ground work in our communities coming to Washington and sharing their stories. And of course, all the leaders and managers and team directors, their messages are so important.

And honestly, they resonate more than, you know, just some, you know, some sort of,  you know, stereotypical, uh, lobbyist, if you will.

Elyssa Katz –Yeah. I’m so glad the Alliance, you know, provided that opportunity for these frontline workers to share their story. I do love a nice watch, but care at home matters more.

Dr. Steve – Landers

Yeah, I think it matters more. And I’m going to tell you a little story right here that I know you probably weren’t expecting. But when I was a student, when I was a college student, I was an intern on Capitol Hill. I was an intern, actually, for the American Heart Association. But my job was to go to Capitol Hill and share the advocacy efforts for related to heart disease.

And I was so, you know, interested in what I saw, especially with some of the physicians that I that I’d go with on their on their visits that I did a study, I did a research project when I went to medical school on the effectiveness of physicians as lobbyists and advocates, and we published it in, I think it was Archives of Internal Medicine.

It was probably like 1990, I know, 1998 or something like that, I don’t know, but the but the point, the take home message of that study that I did as a medical student was that what’s most impactful in in these visits is when people talk about the impact of policy on patients and families. Okay. Of course, we’ve got to talk about the economic issues.

We’ve got to make sure they understand the financing and the regulatory burdens and all of those business issues we face. But our decision makers, the people that were elected, it really resonates with them. When people can come tell the real stories of families and the people they care for.

And that’s what this Advocacy Week is all about. It’s about bringing people from our communities, not professional advocates. This is not, you know, paid activists or lobbyists or whatever. This is the real deal. Our frontline and leaders, regional leaders in hospice and home, health and home care. Coming to Washington and telling their story. It’s one of the most important things we can do.

Elyssa Katz – I’m so glad you shared that. I didn’t know that. That research is fascinating. It’s not surprising coming from you. Things are starting to make a lot of sense, but I think that’s the perfect way to dive into what we talked about. Knowing we had the right messengers coming to the Hill to deliver that message.

Home care 100 is a proud supporter of the Alliance in one voice for care at home. Unity and shared purpose are the foundation for strength and success. The Home Care 100 team salutes the Alliance’s extraordinary first year and looks forward to continued collaboration in 2026, bringing fresh insights, bold thinking and a new approach to home based care is at the heart of everything Home Care 100 does, and it’s even better when we do it together.

Visit HomeCare100. com to learn more.

Elyssa Katz – So now we’ve talked about, you know, what exactly was happening during the Alliance’s Advocacy Week. But now let’s dig into what we were saying. You know, the talking points we dropped, our team worked hard to pull together. What exactly are United Coalition would be talking about? And there are four key areas that we talked about home health.

We talked about hospice and Medicare Advantage, specifically keeping hospice out of Medicare Advantage. We talked about Medicaid and fortifying Medicaid funding, and we talked about telehealth. I want us to dive into all of them, but I’m just going to start with a quick primer on home health, because as listeners know, this is not the first time we’ve talked about home health in this show.

So I don’t think we need to go into the details. But essentially, we said the same song and dance that we’ve sung and danced here that we need to protect access to home health, we need to prevent any further cuts to Medicare reimbursement. And we need to support the Home Health Stabilization Act that helps accomplish exactly that.

So let’s dive into the next topic that advocates were advocating for, and that is keeping hospice out of Medicare Advantage. What was the ask and why does that matter?

Dr. Steve Landers – We had to with Advocacy Week, really focus on a few critical issues. You only get so much time when you get to speak with your member of Congress or their staff. Of course, there’s a number of things that are important to us, but we had to zero in on what are the biggest risks and opportunities for our patients and families.

And so one of the things that we focused on was keeping the Medicare Advantage program in hospice separate from one another. Okay. Hospice is its own managed care model. It’s a holistic, at risk payment model where all of the services that a person needs are paid for through the hospice benefit, and it doesn’t need to be pushed into these Medicare Advantage plans.

Dr. Steve Landers – It’s a recipe for disaster, quite frankly, because hospice is working. Hospice is high value. It’s beloved by families. It saves the system money in many situations. And the, you know, put it into this world of prior authorizations and utilization management and, you know, the insurance plan world just.

It will mess up something that’s been sacred and effective. And we made sure that our members of Congress heard our voice on this. Because the issue, while it doesn’t seem particularly popular, it does keep rearing its head. There are some advocates that are pushing for a hospice to be, um, you know, stuck with Medicare Advantage.

We’re totally against it. It’s a bad idea. And we spoke up.

Elyssa Katz – And just to double click on that, it’s bad for beneficiaries because it has the potential to limit their choice. It’s bad for providers because it introduces administrative burdens that would make it harder for them to deliver care, among other potential issues. But that’s one we know it’s bad for Medicare because hospice already saves Medicare money.

So why introduce complication? And it’s actually probably not good for the Medicare Advantage organizations, because we’ve actually had a demonstration of this before and it didn’t go well. Can you speak a little bit about that demonstration?

Dr. Steve Landers – Yeah, we tried this. Okay. There was a demonstration called V bid, and there was an effort to see what it might look like if Medicare Advantage were to include hospice as part of its program. And it was a logistical nightmare. The systems and processes didn’t work. Even the Medicare Advantage plans didn’t get their payments appropriately.

And so it’s a solution in search of a problem. Quite frankly, we don’t need it. And we should continue to focus on making sure that all Americans have access to the highest quality, most compassionate, most cost effective end of life care possible. And that’s by strengthening and focusing on the Medicare hospice benefit.

Elyssa Katz – Okay. Yes. Um, I should say to that that demonstration was sunset seven years early, which I just find that insane. Like, if that doesn’t show how badly it went, then I don’t know what does. But next topic that we were talking about, which is Medicaid, home and community based services. We’ve talked about Medicaid on the podcast before, but we were really talking about, in broad strokes, funding the front lines, making sure that there was enough funding and support for these programs to continue.

Can you paint the picture of maybe some of the challenges that are happening right now with Medicaid funding, and then why it’s important to invest in Medicaid? ECB’s.

Dr. Steve Landers – So we just went through one of the most consequential pieces of legislation related to the Medicaid program in decades. Okay, earlier this year, where through this one big beautiful bill act or the reconciliation process, there were changes to Medicaid eligibility, funding formulas, work requirements, the state provider tax dynamics that really when you add it all up, it’s projected that a trillion less dollars are going to be going into the Medicaid program over the next decade compared to earlier policy.

So that is a lot of pressure on the Medicaid system. And, of course, one of the most important parts of the Medicaid program are home and community based services. These are personalized, individualized in-home programs that help people with disabilities help older people. Other people with serious illness.

Be able to remain independent in the community. It promotes their participation in the community and in their equality, if you will, as people that might be facing, you know, disabilities. And so the  funding squeeze is inevitably going to put some of these services at risk. Now, the good news, I’d say, with some of these challenges is that they’re staged over time.

It’s highly likely that there will be political decisions in Washington about the timeline of some of these changes, or whether ways to address some of the potential downside of the changes. And so we wanted to make sure with Advocacy Week, that every member of Congress, everybody in the House and Senate understands that they are going to have opportunities to address Medicaid, home and community based services in the coming months and years.

And we want to make sure they understand the value, importance and that they stand up to preserve these services rather than. Rather than let them kind of go away.

Elyssa Katz – Absolutely. I just want to add to that, as seems to be a theme for us, there is already a constraint on a resources and Medicaid home and community based services. As it stands right now, there are over 700,000 people on waitlist for care, and the average time can be more than three years to actually get that care.

So we do not need that problem to get any worse. It is already bad enough and needs to be addressed. So it’s important that we’re having those conversations where there’s still hope for more support. 

The last issue that we talked about is telehealth. And at the time we were asking Congress to make the flexibilities permanent that we had in place in the irony, dark irony here is that we are now experiencing exactly why that’s so important as the government is shut down and we have issues with telehealth, telehealth extension.

Can you speak to number one, why it’s important? And number two, what’s currently happening?

Dr. Steve Landers – So this telehealth issue and there’s a lot of issues around telehealth. But that we’re concerned about is the ability for doctors, advanced practice nurses to use telehealth to certify their patients for hospice care and for home health care. And this was a policy that came about. It’s one of the few good things that came out of the pandemic.

Were these new flexibilities for the use of telehealth. Of course, we have primary care. Advanced practice, nurse palliative and geriatric care. Physician shortages throughout the country. And so we there’s not great access. And when somebody wants and needs home health or needs hospice care, one of the requirements are these evaluations, these medical evaluations.

And we’ve got this flexibility in place to support some of those evaluations when there’s not really another good option to be done via telehealth so that they can have that, you know, evaluation done essentially through video conferencing and make sure that the person’s appropriate for care, it gets certified.

And once it gets certified, then those, you know, nurses and other caregivers can come in and give the person the care that they need. So we’ve had this pandemic era of flexibility that’s really important for access to care, because we have shortages of some of these providers, especially for people living again in rural communities and other places that are hard to reach.

And they need to be reauthorized so that providers can keep using them. You know, it would be a, you know, technically against the law. For providers to use these services if it’s not authorized because it’s something that is, you know, part of the the laws and regulations of home care and hospice. So we have gone to Capitol Hill, and one of the key issues we’ve talked about with our elected officials is the importance of extending, really making it permanent.

Quite frankly, this isn’t going away. You know, with the we’re tripling the number of people 85 and older in our country, we’re not tripling the number of geriatric and hospice and palliative medicine providers in the country. It’s just not happening. We need these flexibilities to maintain access to care.

And you know we’re in it’s 2025. Okay. We can use technology to make health care more accessible and more efficient. And so we’ve been pushing on this. And, you know, as the government is shut down in this continuing resolution, is kind of hung out there and not passed. Those flexibilities have been suspended, essentially, and there are people that are not getting access to care.

So while this is not just a political fight or it’s not just about, you know, whether government employees get their paychecks, which quite frankly, is very important, I wouldn’t want to minimize it at all. But there are also people that are losing their access to home health and hospice care because of these flexibilities.

 Elyssa Katz – Yeah. And I think what’s important to note, too, is that you might think that you’re doing a good thing by requiring in-person care, but these are administrative visits. And what’s really happening is we’re taking away the precious time of these providers from providing the care where it’s needed most, so we can enable the providers to make those decisions themselves and to operate in a way that enables more people to get the care that they need, especially in rural communities where it’s particularly challenging.

So the alliance covered a lot of ground in Advocacy Week. Those were the four issues. Like you mentioned, Doctor Landers. There was a lot that we didn’t talk about, but we had to distill it down to make sure our message got across. And I think we were pretty successful in sharing what we wanted to share.

Dr. Steve Landers – It was a great success. We’ll actually know how great of a success it is as we watch what our elected officials do in the weeks ahead. I want to congratulate all the advocates and all their organizations. You know, the people that came were often representing, you know, entire communities or entire teams, entire regions.

And so there were a lot of people behind them. I felt that, you know, when we got out there that we were not only the people that came in person, but that the rest of our community came with us kind of virtually with their arms around us. As we told these important, we brought these important messages to to Capitol Hill.

Elyssa Katz – And to bring it home. I want to go back to what you said at the top of the episode, which is that no one should be afraid of becoming an advocate. I was scared at my first hill day, and I was with, you know, with the Alliance. I was with an organization that was used to being on the Hill. But I found out that my story really mattered, and I was able to share my personal story with my elected representatives.

And they cared about that. And look at. Yeah, it remains to be seen what happens as a consequence of our advocacy efforts. But we won’t stop trying. And the more of us that we can get to be a part of this movement, the more of an impact that we’ll have. And that’s what’s going to protect patients and families, protect providers, and serve our aging population.

Dr. Steve Landers – Let’s double it in 26. I mean, let’s bring even more people and make even more visits. And let’s hope that we’re talking about new issues, because the ones that we talked about last year have been solved. This is incredibly important, and I’m really proud to be a part of it.

Elyssa Katz – We’ve done a lot of important work, and we know a lot of important work lies ahead of us. When you think about 2026 and what the Alliance will be focusing on, what gives you hope for the future? I think we need a little bit of hope here today.

Dr. Steve Landers – Yeah, I think the thing to be most hopeful about is that we have a winning message. We have a story to tell that is so important for families, people all throughout our country. The work that our members are doing to support people on their hardest days and hardest moments remain independent in their own homes.

This is like an act of humility. It’s an act of humanism and compassion, and it’s so high value because it supports a lower cost health care system. We’re on the right track and that message is not going away. It’s not going to become less important. In fact, with demographics, as these issues around debt and deficit and financing of Medicare become more acute.

What we’re doing is going to continue to be, you know, more, more visible. Also, technology, right, as technology changes. I mean, think of all the things that are happening with AI and, um, and automation and virtual services and things. Those are going to help improve what we can do at home. More people are going to be able to get care at home.

And so that’s going to make it more relevant to policymakers as well. So, you know, 2026, there’s going to be a lot of talk about politics because it is another election year. And so we’re going to actually probably go back to some of the, the polls and some of the things we know about that are important to voters and make sure that as people go to their to their elections, as voters go to the ballot box, that our policymakers understand that what we do, what our members do, what they’re frontline nurses and aides and therapists and social workers and chaplains and the whole team, what they do is critically important is beloved by voters.

So folks, don’t get this wrong. This is not the time to mess up, uh, care at home. It’s not the time to mess up hospice, home health. Uh, your voters are watching what you’re doing. That’s going to be something that we continually remind folks of.

Elyssa Katz – I’m bought in. I’m ready to go. Let’s get the rest of the country riding along with us.