Category: Medicaid
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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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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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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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A Consequential Fight
by James C. Sherlock Michael Martz of the Richmond Times-Dispatch published an excellent report April 15 detailing the three-way fight among Governor Abigail Spanberger and various Democrats in the Virginia Senate and House of Delegates over the budget. The Governor proposed “hundreds of changes” to the competing budget bills proposed by each chamber. Long story…
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Will Union “Dues Skimming” Come to Virginia?
by Chris Braunlich There are many reasons why Governor Abigail Spanberger should veto the collective bargaining bill headed to her desk, a bill requiring local and state governments to bargain with union bosses even if less than a majority of public employees want the union or the bargaining. There is the fact that it will…
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Does Medicaid Pay Enough for Nursing Home Residents?
by James C. Sherlock A reader of the last post in this series asked an excellent question: “Is there such a thing as a highly rated facility that has a high number of Medicaid patients?” His premise was that perhaps Medicaid does not pay enough. In an attempt to answer, the author built a spreadsheet…
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Virginia’s Medicaid Finances
Includes $21.8 million paid to managed care programs for dead enrollees.
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Virginia Nursing Homes – Southwestern Region Update
by James C. Sherlock This article was revised on November 16 to provide a better view of the data. The format the author chose wasn’t getting the job done, so he revised it. Changes in the text are made only to reflect the updated spreadsheet. It should provide more clarity. This is the third article…
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Virginia’s Nursing Homes – Central Region Update
by James C. Sherlock This article was revised on November 16 to provide a better view of the data. The format the author chose wasn’t getting the job done, so he revised it. Changes in the text are made only to reflect the updated spreadsheet. It should provide more clarity. This is the second article…
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Virginia’s Nursing Homes – Eastern Region Update
by James C. Sherlock This article was revised on November 16 to provide a better view of the data. The format the author chose wasn’t getting the job done, so he revised it. Changes in the text are made only to reflect the updated spreadsheet. It should provide more clarity. This will be a sub-series…
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Virginia’s Dreadful Nursing Homes – Part 7 – How to Stop A Deadly Scheme
by James C. Sherlock A brutal pattern is observed repeatedly. Some chains offering the worst nursing homes in America have established a singular process for profit maximization. It is seen in a combination of the Center for Medicare and Medicaid Services (CMS) data on their operating subsidiaries and city/county property records on their real estate…
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Now the Hard Part Begins
by Dick Hall-Sizemore Overlooked in all the news around the election was some sobering budget news for the next governor. As reported by the Richmond Times-Dispatch, the Virginia Dept. of Medical Assistance Services (DMAS) has forecast that Virginia’s Medicaid costs will increase by $3.2 billion over the next three years. That increase consists of an additional…
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Virginia’s Worst Nursing Home Chains – Part Six – A Picture of Deceit
by James C. Sherlock “This nursing home information is confusing, mindbending, and scary. Please draw us a picture to clarify.” Well, readers are right. It is all three of those things. It is meant to be so by some people in the system. Virginia has some excellent nursing homes and chains, but those are not…
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Virginia’s Dreadful Nursing Homes – Part Five – Chain Corporate Structures and the Undoing of the Regulatory Structure
by James C. Sherlock Today, we will examine a big factor in why nursing home regulation fails. It is doomed in part by the organizational structures of chains that mask a deadly lack of corporate ethics. Government regulators not only do not stop it, but are currently helpless to do so for the simplest of…
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Virginia’s Dreadful Nursing Homes – Part Four – Recommendations For 2026 Legislation
by James C. Sherlock This series is being constructed specifically to support legislation in the 2026 General Assembly. To reiterate the legislative recommendations from Part 3: Recommended legislation Consumer protection. Right now, citizens in Virginia Beach and in other communities have no defense against poor and badly staffed nursing homes that charge too much. The…