By BERNARD J. WOLFSON
If you want to create a perfect storm at Covered California and other Affordable Care Act marketplaces, all you have to do is make enrollment more time-consuming, ratchet up the toll on consumers’ pocketbooks, and terminate financial aid for some of the youngest and healthiest enrollees.

And presto: You’ve got people dropping coverage; rising costs; and a smaller, sicker group of enrollees, which translates to higher premiums.

The Trump administration and congressional Republicans have just checked that achievement off their list.

They have done it with the sprawling tax and spending law President Donald Trump signed on July 4 and a related set of new regulations released by the Centers for Medicare & Medicaid Services that will govern how the ACA marketplaces are run.

Among the many provisions, there’s this: Large numbers of lawfully present immigrants currently enrolled in Obamacare health plans will lose their subsidies and be forced to pay full fare or drop their coverage.

Wait. What?

I understand that proponents of the new policies think the government spends too much on taxpayer subsidies, especially those who believe the ACA marketplaces are rife with fraud. It makes sense that they would support toughening enrollment and eligibility procedures and even slashing subsidies. But taking coverage away from people who [Read More]

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

Students Refunded $99 Fee That Professor Sent To Planned Parenthood

A federal judge dismissed a 2023 lawsuit alleging a Michigan State University professor forced students to pay fees she bragged on Facebook went “100%” to Planned Parenthood.

The plaintiffs, Nathan Barbieri and Nolan Radomski, alleged then-marketing professor Amy Wisner compelled her 600 students to pay a $99 membership fee to join “The Rebellion Community,” which the judge described as “an online global learning platform” Wisner controlled and operated.

U.S. District Judge Paul Maloney ruled that Barbieri and Radomski lack standing because they have “not adequately alleged a current or future injury against” Wisner, who was placed on leave when the interim dean of the College of Business learned about the $99 fee, which was refunded to students.

“Plaintiffs do not allege that there will be another course with similar requirements or that plaintiffs would be required to enroll in such a course,” Maloney’s 20-page order reads. “So plaintiffs’ theory that they will be exposed to similar harms is far too speculative to warrant prospective relief. …

“Because MSU refunded plaintiffs’ money, the connection between Wisner’s current or future advocacy and plaintiffs have been severed,” the judge noted, adding that even if the plaintiffs had standing, [Read More]

By STEPHEN SHAVER
Wachler & Associates

Hospice care, once viewed as a relatively quiet corner of the Medicare program, is now under a glaring spotlight. A sharp uptick in provider enrollment, especially in specific regions, combined with mounting evidence of fraud, waste, and abuse, has led the Centers for Medicare & Medicaid Services (CMS) to escalate oversight efforts. From launching new enrollment monitoring protocols to accelerating disenrollment for alleged bad actors, CMS is reshaping the regulatory landscape for hospice care and enforcement trends across the nation may soon come to hospice providers in Michigan.

At the center of this evolving oversight regime is the Provisional Period of Enhanced Oversight (PPEO) a CMS initiative launched to combat fraud among new hospice providers. Initially rolled out and currently active in four states, Arizona, California, Nevada, and Texas, the program targets newly enrolling hospices as well as those undergoing ownership changes or reactivating their billing privileges. Providers placed under PPEO are subject to unannounced site visits, prepayment medical reviews, and heightened documentation scrutiny for up to one year.

The program is often framed as an effort to reduce Medicare fraud or to help providers increase Medicare compliance, and can include multiple rounds of documentation review with provider education between rounds, not dissimilar [Read More]

By DUSTIN PLUMADORE
With the rebound of private equity (“PE”) activity in healthcare across the United States, the Corporate Practice of Medicine and Dentistry (“CPOM” or “CPOD”) has likewise experienced renewed focus by state legislatures and enforcement agencies in 2025.[i]  However, despite this rekindled attention, the often-referenced “Friendly PC” model remains the best structural strategy to ensure post-closing compliance with CPOM and CPOD regulations in most jurisdictions. Constructing a compliant “Friendly PC” structure will probably require the support of expert legal counsel to draft and negotiate the series of agreements necessary for its proper implementation. However, the following paragraphs identify some key considerations for three ancillary agreements, outside of the base transaction documents, commonly used to ensure compliance with CPOM and CPOD.

Friendly PC Model

In the most general sense, the term “Friendly PC” model in PE healthcare deals most often refers to a business arrangement where a physician-owned Professional Corporation (“PC”) sells all of its non-clinical assets to an entity owned by the PE buyer who then takes responsibility for the PC’s non-clinical business operations.  This model complies with CPOM and CPOD laws, which restrict non-physicians from owning or controlling medical practices, because it prevents the PE buyer from owning clinical assets or unduly controlling the [Read More]

A health trade organization’s leader said state lawmakers have the opportunity to create policies and enact legislation to help healthcare and provider communities following the signing of the One Big Beautiful Bill Act (OBBBA).

Michigan Health and Hospital Association (MHA) CEO Brian Peters said during a virtual press call this morning that one issue comes from restrictions on a state’s ability to tax healthcare providers to finance the state’s Medicaid costs that aren’t covered by federal dollars.

However, he said one of the steps the state could take is to use state resources and dollars to fund Medicaid to make up for what is lost by the moratorium on new or increased provider taxes.

Peters said provider tax plans and state-directed payment plans have been critically important for funding Medicaid patients’ care.

“The fact that this program was characterized as waste, fraud and abuse in the conversations leading up to final passage is mind-boggling to me, and we take great issue with that,” Peters said.

Using other state resources to make up for the loss of Medicaid funding from healthcare provider taxes is not a reasonable expectation in the near term unless the state dramatically increases taxes, Peters said. With the bill having been signed into law, Peters said he’s looking down [Read More]

(TROY) – Four Democratic lawmakers representing parts of Oakland County spoke to a filled room about the Medicaid reforms recently signed by President Donald Trump. They predicted heightened administrative costs resulting in services and enrollees being dropped unintentionally, as well as the state having to create new revenue to cover funding losses.

The four Democrats included Reps. Sharon MacDonell (D-Troy) and Natalie Price (D-Berkley), as well as Sens. Stephanie Chang (D-Detroit) and Mallory McMorrow (D-Royal Oak), a 2026 candidate for the U.S. Senate.

The event was held in the Troy Community Center, with more than 110 people inside the room.

Also on their panel were Royal Oak Schools Superintendent Mary Beth Fitzpatrick, Chief Operating Officer Jamie Bragg-Lovejoy of the Michigan Assisted Living Association (MALA) and Lauren Baker, a public policy specialist for the Disability Network Eastern Michigan. Kellie Dobner, Samaritas’ chief growth officer, spoke as well.

“Our association is currently evaluating the impact of the Medicaid cuts in Michigan, even if most funding reductions do not directly impact home and community-based services. The behavioral health system is facing immense pressure which makes it harder for providers to deliver care,” Bragg-Lovejoy said.

Bragg-Lovejoy explained how Medicaid funds personal care services that MALA’s members provide, such as bathing, eating, assistance with using the toilet and giving medications.

But for employees responsible [Read More]

JESSE A. MARKOS, ESQ.
Wachler & Associates, P.C.

The most recent data provided by the Michigan Health Professional Recovery Program (HPRP) for the fiscal year 2024 indicates that a significant percentage of health care providers receiving treatment through HPRP have been subsequently reported by the program to the Michigan Department of Licensing and Regulatory Affairs (LARA) for disciplinary action.  Of course, health professionals struggling with substance abuse should immediately seek treatment. However, the data regarding the percentage of referrals to HPRP that result in disciplinary action suggests that this recovery program may not be the right choice for all providers.

Michigan’s HPRP was established to help health care providers struggling with substance abuse or mental health disorders. Providers can be referred to the recovery program through a “regulatory” referral or a “non-regulatory” referral.  A regulatory referral results from disciplinary action by a licensing board.  These referrals are mandatory and not confidential.  A non-regulatory referral, on the other hand, is voluntary and largely the result of a decision to self-report to HPRP. For these referrals, as long as the provider meets the program requirements, this information is not given to LARA and participation remains confidential.

According to the most recent data provided by the HPRP, 644 of the 435,537 Michigan [Read More]

DAVID J. DAVIDSON, ESQ.
Dickinson Wright

Much has been written about the healthcare policy changes implemented by the 2025 Trump administration. President Trump has issued numerous Executive Orders that establish new policies and rescind actions taken by previous administrations. Robert F. Kennedy, Jr. is overhauling and refocusing Health & Human Services. Dr. Mehmet Oz is implementing new policies at the Center for Medicare and Medicaid Services and auditing Medicare Advantage plans (of which he has been a historical proponent). The Food & Drug Administration is revising its Generally Regarded as Safe standards, fast-tracking approvals of new drugs, minimizing animal testing, and increasing its use of Artificial Intelligence. The National Institute of Health is amending its peer review process.

Much less has been said about the Administration’s enforcement activities within the healthcare industry during this time. That may be due to the fact that while healthcare policy is changing almost daily, enforcement activity has not. Just as there was no abatement in regulatory actions from the Obama administration to the first Trump administration, there has not been a reduction from the Biden administration to the second Trump administration. Nevertheless, from a legal perspective, it is just as important to be aware of how the government is enforcing the laws [Read More]

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

Report On Psychiatric Bed Shortage To Come

In a House committee’s final hearing on the psychiatric bed shortage, Chair Matthew Bierlein (R-Vassar) said the House Oversight Subcommittee on Public Health and Food Security will be compiling a comprehensive report on what they’ve learned and will be recommending legislation based on that.

Bierlein said his office fully intends to continue meeting and collaborating to produce a report based on committee testimony and turn that into legislative recommendations.

One such suggestion would be to invest money in psychiatric beds to reduce the strain on jails, emergency rooms and local law enforcement, which is caused by only 32 adult inpatient psychiatric beds available north of Grand Rapids.

Antonietta (Toni) Petrella-Stanfield, co-founder of Before, During and After Incarceration, said her son died by suicide six years ago after 15 years of struggling to manage a bipolar diagnosis, during which he was hospitalized 15 times for a total of 40 days. He was arrested five times during psychotic episodes for a total of 480 days in jail.

Stanfield said this places a disproportionate burden on county jails.

“Jails are not hospitals. And correctional staff are not mental health clinicians,” Steinfield said.

Forty percent of the Grand [Read More]

Two Democratic-led Senate committees in June adopted a report projecting that the U.S. House Republicans’ proposed Medicaid reforms will create a $2 billion hole in the state budget and drop more than 500,000 beneficiaries due to new paperwork or eligibility obligations.

The report was adopted by the Senate Health Policy Committee, as well as the Senate Appropriations Subcommittee overseeing Michigan’s Department of Health and Human Services. For Sen. Kevin Hertel (D-St. Clair Shores)’s health policy committee, the report was accepted into the panel’s record through an unopposed motion without a roll call vote.

Meanwhile, for Sen. Sylvia Santana (D-Detroit)’s appropriations subcommittee, the report was adopted along partisan lines.

While speaking to MIRS, Santana confirmed the report was more about raising the alarm around the potential impacts of restricting Medicaid on the federal level, as opposed to auditing how the state spends its Medicaid funding.

The report highlighted that on average, Medicaid patients make up 22 percent of hospital patient volume in Michigan. Before the state expanded Medicaid eligibility under Republican Gov. Rick SNYDER, childless adults in the state could earn no more than 35 percent of the Federal Poverty Level (FPL) to receive some Medicaid benefits.

In 2014, it was offered to all adult Michiganders earning under 139 percent FPL, [Read More]

By ARTHUR ALLEN

Within an hour of receiving a COVID vaccination in November 2020, Utah preschool teacher Brianne Dressen felt pins and needles through her arms and legs. In the medical odyssey that followed, she suffered double vision, chronic nausea, brain fog, and profound weakness. Once a rock climber, she became a couch potato.

Although Dressen’s symptoms were rare in that season of hundreds of millions of COVID vaccinations, they were common enough to draw the attention of a National Institutes of Health neuroscientist named Avindra Nath, who examined Dressen and more than 30 other people with a similar syndrome in 2021. He recommended Dressen take steroids and antibodies — treatments that saved her life, she said.

And then, according to emails reviewed by KFF Health News, Nath said he couldn’t help anymore. His clinical study was ending. He directed the patients to seek local help. But, Dressen said, there wasn’t any.

Nath declined to speak to KFF Health News for this article. The FDA searched international vaccine safety databases for small-fiber neuropathy, one of the most common symptoms he mentioned in a write-up of the patients, and found it was less prevalent in vaccinated than in unvaccinated patients, said Peter Marks, who led the FDA division responsible for vaccines [Read More]

By JENNI COLAGIOVANNI & ERIN LIECHTY
Wachler & Associates, P.C.

On May 21, 2025, CMS announced its plan to significantly expand audit efforts of Medicare Advantage (MA) plans. CMS’ expanded audit effort is two-fold: (1) audit all eligible MA contracts for all newly initiated audit payment years, and (2) expedite audits from payment years 2018 to 2024. The Trump administration is turning its attention to these plans because it is estimated that MA plans have overbilled the government between $17 billion and $43 billion annually and because despite the vast overpayment suspected there has been no concerted effort to audit these plans since 2007.

CMS’ MA audit expansion plan is comprised of the use of enhanced technology, workforce expansion, and increased audit volume. CMS states it will use “advanced systems” to find unsupported diagnoses. It is reasonable to assume this may take the form of an AI-driven program to flag unsupported diagnoses presumably for closer review, though CMS has not yet provided the specifics of this enhanced technology. Furthermore, CMS reports that by September 1, 2025, the number of medical coders who manually verify the flagged diagnoses will increase from 40 to 2,000. With these changes, CMS aims to have the capacity to audit all of the [Read More]

By RALPH LEVY
Dickinson Wright

Although in prior articles in this publication, I addressed tax issues faced by physicians and other practice groups, the purpose of this article is to guide physicians and other medical professionals as they compare the taxes payable by them under completing offers to join practice groups. These tax consequences will vary depending on several factors, including whether the offer includes equity ownership and whether or not the group is organized as a professional corporation.

Suppose the offer is for employment without an ownership interest in the practice group, regardless of whether the employer is organized as a professional corporation (PC) or as a professional limited liability company (PLLC). In that case, the tax consequences of cash compensation paid to the employed professional will be the same. The hired professional will be taxed on all cash compensation, including bonuses at ordinary income rates, and Social Security and Medicare taxes will be deducted by the employer. Employees are responsible for Social Security taxes on all annual cash compensation of 6.2% up to the contribution and benefit base for that year ($176,100 for 2025). This means that the maximum Social Security taxes that the employed physician or other professional will pay is $10,918.20 for 2025. In [Read More]

AG Reaches Agreement To Clean Up PFAS-Contaminated Materials

Attorney General Dana Nessel has reached a settlement agreement with Domtar Industries and E.B. Eddy Paper to address releases of per- and polyfluoroalkyl substances (PFAS) at the Techni-Comp Inc. composting site near Port Huron.

Under the terms of the settlement, Domtar has agreed to remove compost piles containing sludges contaminated with PFAS at the site and dispose of the contaminated material in a licensed landfill. In addition, Domtar will investigate PFAS in sediments in surface waters at the site.

The settlement, entered as an enforceable Consent Decree by the 31st Circuit Court in St. Clair County on June 20, includes a $300,000 payment to the Department of Environment, Great Lakes, and Energy (EGLE) to conduct additional response activities to address PFAS at the site. Domtar will also cover the state’s past oversight costs and costs of litigation, including attorney fees.

Nessel filed a lawsuit against the paper manufacturer in December 2022, and it was brought under a state-approved contract with special assistant AGs retained specifically to assist with complex PFAS litigation.

There are currently four PFAS cases filed under the SAAG contract that are pending in both state and federal court.

Gun Bans On Bump Stocks, Ghost Guns, Carrying In The Capitol Pass Senate

Senate Democrats [Read More]

By ELISABETH ROSENTHAL
Health care has proved a vulnerable target for the firehose of cuts and policy changes President Donald Trump ordered in the name of reducing waste and improving efficiency. But most of the impact isn’t as tangible as, say, higher egg prices at the grocery store.

One thing experts from a wide range of fields, from basic science to public health, agree on: The damage will be varied and immense. “It’s exceedingly foolish to cut funding in this way,” said Harold Varmus, a Nobel Prize-winning scientist and former director of both the National Institutes of Health and the National Cancer Institute.

The blaze of cuts have yielded nonsensical and perhaps unintended consequences. Consider instances in which grant funding gets canceled after two years of a three-year project. That means, for example, that $2 million has already been spent but there will be no return on that investment.

Some of the targeted areas are not administration priorities. That includes the abrupt termination of studies on long COVID, which afflicts more than 100,000 Americans, and the interruption of work on mRNA vaccines, which hold promise not just in infectious disease but also in treating cancer.

While charitable dollars have flowed in to plug some gaps, “philanthropy cannot replace federal funding,” [Read More]

A massive tax cut/Medicaid reform bill that cleared the U.S. House this month has sparked a messaging war at all levels of politics between Republicans and Democrats attempting to frame the issues for the public.

For Republicans, the “One Big Beautiful Bill” makes tax cuts from President Donald Trump’s first term permanent, but for Democrats, the changes to how Medicaid is administered mean “people will die.”

All the while, both sides are sidestepping the significant debt that comes with the plan, which still needs U.S. Senate approval to get to Trump’s desk.

U.S. Reps. Debbie Dingell (D-Dearborn), Haley Stevens (D-Birmingham) and Gov. Gretchen Whitmer took aim at the cuts the bill would administer to Medicaid and the Supplemental Nutrition Assistance Program (SNAP). The Congressional Budget Office shows Medicaid spending would be reduced by $700 billion and SNAP spending would be reduced by about $276 billion over 10 years.

“People will die, children will go hungry, and working Americans will continue to struggle to make ends meet, all so Republicans can give another tax break to billionaires,” Dingell said in a press release.

State House Democrats also held a press conference railing against the passage of the federal reconciliation bill with Reps. Ranjeev Puri (D-Canton), Stephanie A. Young (D-Detroit) and Jennifer [Read More]

By KAITLYN DELBENE
Wachler & Associates, PC

A press release from the U.S. Department of Health and Human Services on March 27, 2025, announced a self-described “dramatic restructuring” of the Department as part of the administration’s efforts at “workforce optimization.” Among other changes, the press release revealed a plan to slash the HHS workforce by 25 percent and announced oversight of certain HHS offices by a new Assistant Secretary for Enforcement. As these sweeping changes are implemented, providers should be aware of possible ramifications for their practices. The cuts to the HHS workforce have been challenged in a lawsuit by 21 states and the District of Columbia, though no injunction has yet been sought or ordered; in the meantime, the organizational restructuring—including the consolidation of 28 agencies into 15—is likely to be felt by Medicare providers interacting with HHS on policy, regulation, enrollment, and audit matters.

New Approach to Enforcement
HHS announced that it will create a new Assistant Secretary for Enforcement to oversee the Departmental Appeals Board (DAB), Office of Medicare Hearings and Appeals (OMHA), and Office for Civil Rights (OCR) in order to “combat waste, fraud, and abuse in federal health programs.” No further detail has yet been provided as to the Assistant Secretary role or whether [Read More]

Healthcare Michigan – Michigan’s 21st Century Healthcare News Source

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

UIA Director Testifies In Oversight Subcommittee About $8-$15 Billion In Fraud During COVID-19
The House Oversight Subcommittee on State and Local Assistance Programs heard testimony from Michigan Unemployment Insurance Agency (UIA) Director Jason Palmer over the agency’s handling of pandemic-era unemployment benefits, which resulted in an estimated $8 to $15 billion in overpayments.

The meeting focused on two reports from the Office of the Auditor General (OAG) that detailed widespread fraud, mismanagement, and systemic failures within the UIA during the COVID-19 pandemic. Palmer, who took over the office just 86 days prior, acknowledged the agency’s past failures and pledged full cooperation with the committee to prevent future fraud.

“I own it now,” Palmer said, affirming his commitment to reform, despite not leading the agency during the time of the problem.
“We are building an agency that doesn’t just react to crisis, but delivers reliably every day,” said UIA COO Brett Gleason.

The committee scrutinized the UIA’s decision to disable its “Fraud Manager” software early in the pandemic, a move that coincided with a surge in fraudulent claims. According to the Deloitte audit cited during the hearing, the agency saw a $2.5 billion drop in likely impostor claims [Read More]

(ROYAL OAK) – Michigan’s health department was assigned to craft a report detailing the impact of potential future federal Medicaid cuts as part of an executive directive Gov. Gretchen Whitmer penned this month at a press event at Beaumont University Hospital.

The U.S. House is considering up to $880 billion in Medicaid cuts over 10 years, which KFF (formerly the Kaiser Family Foundation) projects represents 29 percent of state-financed Medicaid spending per resident, to cover the costs of extending tax cuts President Donald Trump signed in 2017.

U.S. Rep. Debbie Dingell (D-Dearborn) said House Republicans have circled May 7 on the calendar as the day they will roll out more details on the reductions, which she said is not about presenting a balanced budget.

The tax cuts in question come from the Tax Cut and Jobs Act (TCJA) of 2017, which lowered individual income tax rates and increased standard deductions, but also lowered the corporate income tax from 35 percent to 21 percent.

Also joining Whitmer in the hospital’s serene sixth floor atrium were U.S. Reps. Haley Stevens (D-Birmingham) and Rashida Tlaib (D-Detroit), as well as Dr. Dan Carey, president of Corewell Health William Beaumont University Hospital and several other white coats.

Medicaid is the third-largest mandatory program in the federal budget, accounting for 9 percent of federal [Read More]

Nearly nine years ago, Faith Brown watched her armed husband kill her four children after she served him divorce papers. Now she visits the Capitol with a funding request to legislators, saying Michigan’s newest gun laws won’t protect domestic violence survivors if shelters close.

“He killed our four children in front of me. He shot me, cut me with a knife and left me for dead. What was so chilling was how calm he was. He wasn’t angry. He didn’t yell. He just did it,” Brown said. “I remember waking up in the hospital. A social worker gave me a folder with resources to try to help me put my life back together. I still have that folder.”

On April 22, around 100 individuals gathered behind the Capitol to kick off the “Team Enough” lobby day, calling for various firearm reforms.

Some of today’s policy requests were intended to build off statutes adopted by the previously Democratic-controlled state government in the 2023-24 term. For example, in May 2023, the governor signed off on creating Extreme Risk Protection Orders (ERPOs), so family members, spouses and romantic partners could petition the courts to have someone’s guns temporarily confiscated.

Later, in November 2023, the governor signed legislation banning individuals convicted of misdemeanor domestic violence [Read More]