Category: Health Care
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Getting Control of Nursing Home and Autism-Treatment Chains
by James C. Sherlock Virginia is awash with out-of-state nursing home and behavior-analysis chains operating as LLCs. Our state regulators know little to nothing about them and have no control over their presence in Virginia because they are not licensed by those regulators. The problems we are experiencing in both industries are centered on rogue…
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Widespread Inaccuracies of Records on Autism Treatment Providers
By James C. Sherlock The author has completed a detailed survey of individual Applied Behavior Analysis (ABA) providers in New Jersey licensed by Virginia Medicaid to provide services to children with autism. He picked New Jersey for reasons familiar to readers of his work on nursing home chains. The survey revealed that most of those…
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Did Anyone Even Notice?
by James C. Sherlock As a good citizen, this author was about to send a courtesy copy of today’s article, “Autism in Virginia,” to the Virginia Behavior Analyst Advisory Board, which helps the Board of Medicine regulate licensed behavior analysts. He found that the Behavior Analyst Advisory Board hadn’t met in a year. It…
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Autism in Virginia
by James C. Sherlock Autism therapy is the wild west of medical qualifications and spending. Autism is real, but industry professionals and the non-profits who lobby for limitless autism spending have richly earned widespread skepticism of the industry by not policing their own. They have created a closed loop for eternally increased spending: The profession…
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Drip, Drip, Drip
The truth slowly emerges about what UVA leaders knew about the Health System scandal. by The Jefferson Council A bombshell disclosure in a recent FOIA proceeding reveals that UVA’s Board of Visitors, led by Robert Hardie, quietly retained Williams & Connolly (W&C) as “special counsel to the BOV and the Audit, Compliance, and Risk Committee…
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Nobody Home
by James C. Sherlock Last week, I conducted a short field survey in Virginia Beach of four businesses registered with the federal government to bill Medicaid as providers of Applied Behavior Analysis (ABA) (i.e., autism) services. Each is headquartered in Lakewood, NJ. Lakewood is, of course, the location of the Medical Facilities of…
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Autism-related Vulnerability of Virginia Medicaid
by James C. Sherlock Virginia is not doing enough to prevent Medicaid fraud. Our attempts are hampered by the dysfunctional design of the state regulatory system. They often fail because they cannot work. This piece will focus on behavioral health and recommend specific actions, but the entire healthcare regulatory system needs an overhaul. Absent that,…
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Clown Show
by James C. Sherlock Statutory powers and responsibilities do not bestow competence. The General Assembly created the Office of the State Inspector General (OSIG) within the Office of the Governor in 2011. The powers and duties of that office are defined in Code of Virginia § 2.2-309. The role focuses on detecting fraud, waste, and abuse…
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The Integrity of Healthcare Programs in Virginia – Part 2 Forests and Trees
by James C. Sherlock Federally-funded programs administered by the states are primary targets of fraud and abuse because of the vast sums at stake. The amount of money at risk is literally unimaginable. Medicare and Medicaid alone exceed two trillion dollars a year. Federal programs are widely victimized in Virginia because the Commonwealth does not…
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The Bravest Democrat in the 2026 General Assembly took on Louise Lucas
by James C. Sherlock You know how sometimes you try to do the right thing for the right reason, and it blows up in your face? One of the newest members of the General Assembly is freshman Delegate Garrett McGuire, D-Fairfax. He is either the bravest of the Democrats or one who committed a…
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Government Oversight of the Integrity of Healthcare Programs in Virginia – Part 1
by James C. Sherlock This author’s unbroken experience over many years has been that majorities in the General Assembly have sought to protect the healthcare industry from competition (COPN) and leave it alone to operate as it sees fit. They have not wanted oversight because many of their largest donors and most influential constituents in…
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In the Business of Health Care Fraud, Virginia is Minnesota
by James C. Sherlock Health care fraudsters are often treated by Virginia elected officials in the same way moonshiners were in this state, as local heroes pursued only by the feds. Many prefer not to interrupt the product flow. They simply want a taste from the jar. Dick Hall-Sizemore, a dedicated contributor to BR and a good…
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A Solution to the Threats to Medicaid in Virginia
by James C. Sherlock Medicaid fraud is not a new issue, but it has exploded into the public consciousness as the Trump administration has taken action against it. Virtually every critique of Medicaid fraud, from both sides of the debate over how pervasive and costly it is and what to do about it, has been…
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What Could Possibly Go Wrong?
Read the City Journal article here.
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Table Stakes: Virginia Nursing Home Chains Selling to REITs
by James C. Sherlock Sometimes, when you are winning big in a table stakes poker game, it can be time to put some money in your pocket. That is part of the game many nursing home chains are playing these days. Everybody wins but the nursing facility residents, Medicare, and Medicaid. The enterprise architecture of…