By Sally C. Pipes

The Department of Government Efficiency’s crackdown on waste, fraud, and abuse is off to a fast start. But as an engine of government savings, DOGE still has substantial untapped potential.

That’s because it hasn’t yet addressed the fraud crippling one of the federal government’s largest programs: Medicare. In fiscal year 2023 alone, “improper payments” in Medicare eclipsed $50 billion.

GUEST OPINION

If DOGE wants to put a real dent in government overspending while changing millions of Americans’ lives for the better, it won’t find a better target than Medicare fraud.

The legacy of Medicare after 60 years is one of relentless growth — both in the number of beneficiaries and in spending. Medicare expenditures now exceed $1 trillion annually.

But the program’s growth has only weakened its ability to effectively oversee its finances — creating a fat target for scam artists who calculate their odds of success are high and their risk of getting caught is low.

The numbers paint an alarming picture. In fiscal year 2024, 7.66% of the payments Medicare’s Fee-for-Service program made to providers were “improper,” meaning they failed to comply with legal requirements. Those payments totaled more than $31 billion.

The improper payment rates for Medicare Advantage and the Medicare prescription drug benefit were not much better — 5.61% and 3.70%, respectively. That translates into a total of over $22 billion in improper payments across the two programs in fiscal 2024.

In all, Medicare accounts for nearly one-fourth of the funds improperly spent by the government each year, according to a report from the Government Accountability Office.

That’s a pitiful record — and has real human consequences, both for seniors and for taxpayers.

Consider some of the most egregious cases of Medicare fraud. Earlier this year, a couple from Arizona “pleaded guilty for causing over $1.2 billion of false and fraudulent claims to be submitted to Medicare and other health insurance programs for expensive, medically unnecessary wound grafts that were applied to elderly and terminally ill patients,” according to the U.S. Department of Justice.

In 2023, the Department of Justice charged 23 Michigan residents with nabbing more than $61.5 million from Medicare for unnecessary home health services. The feds allege that the defendants set up a complex web of home healthcare agencies in Detroit using straw owners — such as family members — and then paid bribes and kickbacks to recruiters to gain additional patients.

Every dollar spent improperly — or fraudulently — in Medicare is a dollar that can’t go to a senior with legitimate healthcare needs.

Policymakers have already identified numerous concrete strategies for reforming the program. One is to ensure that Medicare pays the same amount for equivalent services no matter where they’re provided. This change, which has long been championed by GAO, could save taxpayers more than $140 billion over the next decade.

Another potential reform would be to conduct more thorough audits of payments and claims. Auditors working at the state level have historically been successful at identifying fraud. Using their insights to improve federal Medicare oversight could help policymakers keep managing the program effectively as it continues to grow.

Work of the sort DOGE is doing is sorely needed. Waste and fraud run rampant in the federal government. Reforming Medicare can save not just money but lives.

Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The World’s Medicine Chest: How America Achieved Pharmaceutical Supremacy — and How to Keep It (Encounter 2025). Follow her on X @sallypipes. This piece originally ran in the Detroit News.

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Juvenile detention centers are meant to be a place to help young offenders reform their ways. However, for many of these young offenders, this place becomes one of fear, abuse, and exploitation.

Many juveniles face various forms of sexual violence from other detainees and staff members, and due to their lack of power, isolation, and young age, they might be completely vulnerable to such forms of sexual violence.

If a juvenile were to ever face such problems, they have the right to contact a juvenile detention sexual abuse lawyer to get justice for the crimes committed against them.

This blog explores the various types of sexual violence juveniles are susceptible to at a detention center.

1. Sexual Abuse 

Sexual assault is when a perpetrator uses manipulation, coercion, threats, etc., to force another to perform sexual acts. Sexual abuse is often a repeated or long-term form of sexual exploitation. Sexual abuse often occurs when there is a power imbalance between the victim and the abuser, so an abuser can be another juvenile or even a staff member.

2. Sexual Assault 

Sexual assault is when a person forces or intentionally does sexual acts on another without their consent. Sexual assault can include groping, fondling, forcing oral sex, etc. As the perpetrators can be both other juveniles or staff members, victims often do not report such cases to avoid further mistreatment.

3. Intimate Partner Sexual Violence 

It is likely that people who are in the detention center together form relationships. Such relationships could be for various reasons, such as genuine romantic interest, coercion, and the desire to feel safer. Even if there is a relationship between two people, there still might be sexual violence involved.

One partner could force, manipulate, or use other tactics to make the other perform sexual acts. But, if the act was done without the other’s consent, the act is considered sexual violence.

4. Drug-Facilitated Sexual Assault 

Perpetrators can use various ways to get what they want, even if it means making their victim addicted to substances. Many perpetrators coerce or force their victims to use drugs or sedatives to either get them addicted and use their addiction as a tool or get the victim to lower their defenses to commit sexual acts. It is important to keep in mind that any sexual act that was done without the consent of both parties is considered an act of sexual violence.

5. Sexual Harassment 

Some acts, though they do not involve physical touch, can be just as traumatizing. Sexual harassment is one such act of sexual violence. Sexual harassment includes sexual gestures, comments, noises, unwanted advances, etc. Such acts of sexual violence can create a hostile environment, leading to serious psychological issues for the victim.

6. Rape 

Rape is when a person is forced or coerced to perform sexual intercourse. Rape often involves the use of violence and threats to instill fear or to physically force one party to perform penetrative sex. As it is an act of sexual violence that severely violates the victim’s rights over their own body, rape can lead to severe physical and emotional trauma.

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In Chesterfield County, S. Carolina, on Dec. 28, 2024, a man entered a convenience store around 8:45 p.m. and put a gun to the clerk’s head, demanding money. The clerk, however, was also armed and, fearing for his life, managed to draw his own firearm and shoot the assailant multiple times, killing him. Security cameras in the store confirmed his account and no charges are expected against the defender. The Sheriff reminded citizens: “A person who is not engaged in an unlawful activity and who is attacked in another place where he has a right to be, including his place of business, has no duty to retreat and has the right to stand his ground and meet force with force, including deadly force, if he reasonably believes it is necessary to prevent death or great bodily injury to himself or another person or to prevent the commission of a violent crime.” (Chesterfield County Sheriff’s Office Facebook, Chesterfield County, S.C., 12/30/24)

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On the morning of Dec. 8, 2024, a man broke into an apartment in West Chester, Ohio, through the balcony door. An armed citizen was home, however, and, after hearing noises, found the intruder and shot him. The suspect was transported to the hospital but died there; the investigation was ongoing. (wcpo.com, Cincinnati, Ohio, 12/8/24)

An armed robber entered a gas station convenience store Dec. 21, 2023, around 1 a.m. in South Bend, Ind., and demanded money from the clerk at gunpoint. When the man then got into an altercation with the clerk, a customer believed the clerk to be in danger of his life, so he drew his firearm and fatally shot the assailant. The would-be robber managed to flee the store but collapsed nearby. The store’s security footage quickly confirmed the armed citizen’s account of events and the prosecutor was able to tell reporters the same day that the shooting was justified in defense of someone’s life and they would not seek to press charges. (wndu.com, South Bend, Ind., 12/21/23)

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On New Year’s Day, a masked man allegedly entered a Taco Bell in Akron, Ohio, pulled out a gun and fired at an employee behind the counter. Another employee, a 21-year-old man, drew his own gun and fired back at the assailant, striking him in the chest. The would-be robber then fled with some of the money, only to show up at the hospital a short time later. Another man, who drove him to the hospital and who was apparently involved in the incident in some way, was arrested. The wounded suspect was in stable condition and was expected to face charges upon release. The police chief said, “To some degree, [he] could’ve saved or prevented someone from being seriously injured or killed—himself or others.” (news5cleveland.com, Cleveland, Ohio, 1/2/24)

On Jan. 21, a woman in Fruita, Colo., discovered an intruder in her home. To protect the victim, reports don’t provide many details on the incident, but do indicate that the woman was able to defend herself with her firearm, causing the man to flee. Fruita police reminded area residents to always keep their homes and cars locked and to “take all precautions necessary to protect yourself and your property, regardless of how safe you think your neighborhood is.” (kjct8.com, Grand Junction, Colo., 1/22/24)

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A homeowner in Georgia, Vt., used a muzzleloading rifle to defend himself against several home intruders just before midnight on Jan. 30. The three suspects reportedly were forcing entry through a locked door. The homeowner shot one of the alleged intruders, a 39-year-old man, critically wounding him, then shut the door and called police. The other would-be home invaders fled before police arrived, but officers found the wounded man in a neighbor’s yard and transported him to the hospital. The investigation was still ongoing. (mychamplainvalley.com, Colchester, Vt., 1/31/24)

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On Feb. 11 in East Greenwich, R.I., a man called police to report that a man wielding a knife had followed him into his garage and demanded his car. The homeowner, however, was an armed citizen, and the suspect ran off after he drew his firearm. He was later found allegedly using a rock to break into a nearby home through the sliding-glass door. Police quickly arrested the 30-year-old suspect, who faces multiple charges. (wmur.com, Manchester, N.H., 2/11/24)

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PUBLISHED HERE WITH PERMISSION OF THE NRA

By Sally C. Pipes

In its final days in office, the Biden administration finalized a rule to eliminate nearly $50 billion in medical debt from 15 million Americans’ credit reports.  But the rule betrays a complete misunderstanding of health economics — and like former President Biden’s other market interventions, it may only serve to make Americans worse off.

Medical debt simply isn’t the crisis many have made it out to be. A recent analysis from the Peterson-KFF Health System Tracker found that just 8% of American adults hold medical debt. Among those with outstanding healthcare bills, roughly half owe less than $2,000. Just over one in seven of those with debt — roughly 1% of American adults — owe more than $10,000.

Many debtors have solid plans to pay unexpected medical bills, according to KFF polling. More than one-third of respondents with current healthcare debt said they’d put a $500 medical bill on a credit card and pay it off over time or in full at the next statement. Another 15% said they’d pay the bill immediately using cash, check, debit card, or a Health or Flexible Savings Account. Around 7% said they’d make a payment plan with their provider.

So it seems that medical debt is at least manageable for most of those who hold it. And considering the average American holds more than $90,000 in total debt, medical debt is far from the largest source of financial strain.

That explains why past actions to forgive medical debt haven’t resulted in meaningful improvements to Americans’ lives. Indeed, a recent National Bureau of Economic Research paper found that large-scale healthcare debt relief had no effect on patients’ mental health, physical health, or financial wellness.

There’s a strong chance that the Biden administration’s last-minute move to minimize medical debt will have a negative impact on those who have it. Without an accurate picture of the debts people owe or have paid, lenders may become more cautious about offering money to borrow in the first place.

The result would be less available credit for many Americans — not more.

Obscuring medical debt could lead some lenders to approve loans for people whose credit scores wouldn’t have been high enough to qualify otherwise. But if those borrowers aren’t prepared to repay the loans, they could end up defaulting and face even more financial hardship.

Either scenario will increase uncertainty around loan repayment — and thereby incentivize lenders to raise interest rates. That will disproportionately harm low- and middle-income Americans, who already face a tougher time getting approved for loans and consistently making payments.  

Some may even need to turn to alternative sources of funding, such as high-interest payday loans.

Then there’s the possibility that the rule could compel providers to ask for payment up front. If that happens, some patients could find it harder to access care.

The NBER paper found that policies related to medical debt forgiveness led to reductions in payments of existing healthcare bills. That makes sense. If patients know their medical debt might be forgiven — or, at the very least, won’t appear on their credit report — they’ll prioritize paying their other debts first.

The Biden administration claimed its medical debt rule would offer financial relief to millions of Americans. It may have just the opposite effect — and make it harder for people to access care to boot.

Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The World’s Medicine Chest: How America Achieved Pharmaceutical Supremacy — and How to Keep It (Encounter 2025). Follow her on X @sallypipes.

By Dr. Kenneth E. Thorpe

Just before the inauguration, the outgoing Biden administration announced 15 new medications that’ll be subject to government price negotiations under the Inflation Reduction Act. The new prices, which only apply to Medicare, will officially take effect in 2027.

Many will celebrate this government pricing as a win for affordable healthcare, but the reality is far more complex. In fact, for the tens of millions of Americans managing chronic conditions, government price-setting could end up making it harder to access life-saving treatments.

The fundamental driver of America’s healthcare affordability crisis isn’t drug prices themselves — it’s the complex system of rebates, discounts, and market distortions created by insurance companies and middlemen called pharmacy benefit managers. These entities act as gatekeepers between drug manufacturers and patients. Insurers and PBMs negotiate steep discounts for themselves while saddling everyday people with exorbitant out-of-pocket costs.

Just last month, the Federal Trade Commission revealed that three major PBMs marked up drug prices by hundreds or thousands of percent at their affiliated pharmacies, generating $7.3 billion in revenue above the drugs’ acquisition costs.

Government pricing will further encourage insurance companies to push patients toward the cheapest medicines, regardless of what their doctor might have prescribed. When Medicare artificially lowers the price for one drug — say, a breast cancer treatment — it creates a ripple effect across the market for all similar medicines. While insurers must cover the negotiated drug, they can use bureaucratic rules to push patients toward whichever option brings them the highest profits, whether that’s the negotiated drug or alternatives with bigger rebates.

These aren’t just hypothetical concerns. Medicare itself has acknowledged that insurers will likely respond to these prices by requiring more paperwork before covering some medications, forcing patients to try cheaper options first, or imposing strict quantity limits. Put simply: Medicare drug price negotiations could lead to more red tape between patients and the treatments they need.

The IRA compounds these challenges with a puzzling double standard: “Small molecules” that typically come in the form of pills or tablets face price-setting after they’ve been on the market for nine years, while injectable medicines called “biologics” get 13 years of exemption. This arbitrary “pill penalty” threatens to upend pharmaceutical innovation in ways that particularly harm chronic disease patients.

Here’s why: Some novel drugs can earn as much as half of their revenue in the final years before their patent protections expire, typically around 13 years after they reach the market. By shortchanging pills by four years, the IRA creates a powerful incentive for companies to prioritize investments in biologics.

Fortunately, there’s growing bipartisan recognition of this oversight in the IRA. The Ensuring Pathways to Innovative Cures (EPIC) Act would eliminate the pill penalty by giving all drugs the same 13-year reprieve from Medicare pricing. This wouldn’t solve everything, but it would remove an artificial barrier to developing the kinds of treatments many chronic disease patients prefer.

By fixing these shortcomings, policymakers can ensure the IRA fully delivers on its promise of affordable, accessible care.

Kenneth E. Thorpe, PhD is the Robert W. Woodruff Professor of Health Policy at Emory University and Chair of the Partnership to Fight Chronic Disease (PFCD). This piece originally ran in RealClearHealth.

Activities at front desks influence patients’ experiences and the effectiveness of healthcare services. As the primary point of contact, the front desk staff welcomes patients, arranges visits, checks insurance records, and enhances provider communication. This dynamic workplace requires empathy and organizational ability to satisfy customer needs while preserving operational flow.  Medical practices may greatly raise patient happiness and simplify their whole process by prioritizing effective front desk administration, helping produce better health results.

The front desk operations

The front desk of a medical office is like its pulse; initial impressions are created, and important administrative chores are carried out there. Receptionists precisely answer phones, schedule appointments, handle a consistent patient flow, and check insurance information. They also answer patient questions so everyone feels welcome and updated about their appointment. Staff members negotiating the complexity of patient requirements while preserving a seamless operational flow call for a combination of multitasking abilities and empathy in this busy setting. Many clinics use companies like scribe-x.com for simplified administrative support in order to improve productivity and patient satisfaction even more. The smooth running of the practice depends on effective front desk operations.

Patient check-in and check-out process

The whole experience in a medical practice depends on the welcome of patients and the guarantee of a flawless exit. When people arrive, friendly staff members welcome them and compile the required information, including medical history and insurance details, thereby confirming their appointments. Staff members work to establish a comfortable environment; hence, this first check-in shapes the tone of the visit. Following consultations, the check-out process schedules follow-up visits and addresses any required documentation or payment, preserving the continuity of treatment. Every activity is meant to reduce waiting times and improve patient happiness. Hence, it is a necessary part of the operations of the practice.

Managing appointments and scheduling

Maintaining a medical practice in good operation depends on effectively coordinating patient appointments. Scheduling tools help staff members balance patient demands with provider availability to handle appointments. This covers scheduling first consultations and allowing follow-up visits and urgent demands. Flexibility is important since last-minute cancellations or rescheduling calls for swift changes to maintain the best possible timetable. Ensuring suitable filling of appointment slots and timely reminders for patients would help the practice maximize provider productivity and minimize gaps in service, thus improving general patient care.

Coordination of care and communication with providers

High-quality patient care depends on effective communication among healthcare providers. To ensure patient care agreement, staff assist doctors, nurses, and experts in communicating information. We review test results, treatment strategies, and patient issues during appointments. Electronic health records (EHR) facilitate this procedure by providing real-time patient histories and updates. A collaborative environment enhances patient outcomes and provides a more seamless treatment experience.

Conclusion

Medical practice front-desk operations are critical to patient experience and healthcare delivery. Front desk staff contribute to the practice’s success by promoting efficient communication, convenient appointment booking, and a welcoming environment. They must manage administrative activities and provide sympathetic assistance to foster a good environment that promotes treatment continuity and optimal health outcomes. A functional front desk that emphasizes the significance of each patient interaction is critical to a medical practice’s success.

As 2026 approaches, significant changes are coming to Medicare Advantage plans. Whether you’re currently enrolled or considering enrolling, staying informed about these updates is crucial to ensure you make the best healthcare decisions. Let’s take a closer look at the expected changes, how they may impact beneficiaries, and what you can do to prepare.

Key Changes to Medicare Advantage Plans in 2026

Medicare Advantage plans, also known as Medicare Part C, are private insurance options that provide additional benefits beyond Original Medicare. In 2026, several modifications are expected to reshape these plans, focusing on affordability, coverage, and regulatory measures.

1. Enhanced Telehealth Services

Telehealth has become an integral part of healthcare, and Medicare Advantage plans 2026 will further expand telehealth services. This means:

• More access to virtual doctor visits and specialist consultations.
• Broader coverage for remote monitoring of chronic conditions.
• Improved accessibility for rural and underserved areas.

2. Stricter Regulations on Out-of-Pocket Costs

To protect enrollees from excessive healthcare expenses, new regulations will cap out-of-pocket costs. The federal government aims to:

• Reduce annual out-of-pocket maximums.
• Implement better price transparency for medical services.
• Ensure that beneficiaries are not overburdened with unexpected medical bills.

3. Expanded Supplemental Benefits

Many Medicare Advantage plans offer supplemental benefits such as vision, dental, and hearing coverage. In 2026, expect:

• More comprehensive dental care, including routine exams and advanced procedures.
• Improved hearing aid coverage with lower out-of-pocket costs.
• Vision benefits that cover additional eyewear options and preventive care.

4. Changes to Prescription Drug Coverage

With rising drug prices, Medicare is making adjustments to prescription drug coverage in Medicare Advantage plans. Changes may include:

• Lower copayments for essential medications.
• Expansion of generic drug options.
• Improved access to specialty drugs for chronic conditions.

5. Stronger Network Requirements for Providers

Starting in 2026, insurers will need to meet stricter provider network requirements to ensure beneficiaries have sufficient access to healthcare professionals. This means:

• More in-network providers for better accessibility.
• Stricter enforcement of network adequacy rules.
• Fewer issues related to surprise billing from out-of-network providers.

6. Better Integration of Mental Health Services

Mental health services have often been overlooked in Medicare Advantage plans. The 2026 updates will introduce:

• Expanded access to therapy and counseling sessions.
• More coverage for psychiatric medications.
• Greater emphasis on holistic and preventive mental healthcare.

7. Changes in Plan Availability and Competition

Competition among Medicare Advantage providers will increase due to regulatory reforms, leading to:

• More plan options tailored to diverse needs.
• Improved plan comparisons for beneficiaries.
• Potential reductions in premiums due to competitive pricing.

How These Changes May Affect You

If you’re currently enrolled in a Medicare Advantage plan or considering switching, these changes will likely impact:

• Your choice of providers – New network requirements may change the doctors and hospitals available to you.
• Your costs – Lower out-of-pocket caps and prescription drug adjustments could reduce healthcare expenses.
• Your benefits – Expanded coverage for telehealth, mental health, and supplemental benefits may provide more value.

What You Should Do to Prepare

To ensure you’re ready for the changes coming in 2026, consider these steps:

• Review Your Current Plan – Compare your current benefits with upcoming changes to see if your plan remains the best fit for your needs.
• Stay Informed – Follow Medicare updates and announcements to be aware of policy adjustments.
• Explore New Plan Options – With increased competition, you may find better coverage or lower costs by switching plans.
• Speak with a Medicare Advisor – A licensed Medicare professional can help you navigate the updates and make informed decisions.
• Assess Your Healthcare Needs – If your health status changes, ensure your Medicare Advantage plan aligns with your evolving medical requirements.

Final Thoughts

The upcoming changes to Medicare Advantage plans in 2026 bring both challenges and opportunities for beneficiaries. With enhanced benefits, stricter cost regulations, and improved accessibility, the adjustments aim to create a more balanced healthcare system for seniors. By staying informed and proactive, you can make the best choices for your healthcare future.

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