RISE summarizes recent regulatory-related headlines and reports.
ACA marketplace premiums set to rise next year
A new analysis from the Peterson-KFF Health System Tracker finds that the median proposed increase for premiums in the Affordable Care Act (ACA) marketplace in 2026 will go up 18 percent, more than double last year’s seven percent median proposed increase.
The analysis is based on initial rate filings from 312 insurers in all 50 states and the District of Columbia for ACA marketplace plans. The rates are preliminary and may change before being finalized, KFF said in an issue brief. Reasons for the increase are due to rising costs, use of services, and the expiration of enhanced premium tax credits.
California woman sentenced to nine years in federal prison for $10.6M hospice fraud scheme
Nita Almuete Paddit Palma, 75, of Glendale, Calif., was sentenced this week to 108 months in federal prison for participating in a scheme in which hundreds of thousands of dollars in illegal kickbacks were paid and received for patient referrals that led to the submission of approximately $10.6 million in fraudulent claims to Medicare for supposed hospice care. The Department of Justice said that Palma was also ordered to pay $8.2 million in restitution.
In December 2024, a federal jury found Palma guilty of 12 counts of health care fraud and 16 counts of paying illegal kickbacks for health care referrals. According to the DOJ, Palma was excluded from Medicare because of prior federal convictions for receiving illegal kickbacks. While she was excluded from Medicare, Palma purchased Magnolia Gardens Hospice through her daughter and bought C@A Hospice through her husband in 2015 and concealed her ownership interest in both hospices from Medicare.
Palma then paid “marketers” hundreds of thousands of dollars in illegal kickbacks for patient referrals that Palma could bill to Medicare for supposed hospice care.
Through Magnolia Gardens Hospice and C@A Hospice, Palma’s scheme led to the submission of $10.6 million in fraudulent claims to Medicare beginning in 2015 for hospice care for patients that were not dying. Palma received approximately $6,000 each month a patient was billed to Medicare for hospice. In turn, Palma paid marketers up to $1,000 per month for illegal kickbacks for each patient referred to her that was billed to Medicare for hospice. Many of the patients that were billed to Medicare through Magnolia Gardens Hospice did not know they were signed up for hospice, and some patients only found out after they were denied medical coverage for services they needed.
During the health care fraud scheme, Medicare requested additional documentation from Magnolia Gardens Hospice to support the purported hospice claims. In response, Palma and her husband directed employees to create fake patient charts and had those fake patient charts submitted to Medicare. Court documents allege that while awaiting trial, Palma took control of three other hospices and caused the submission of approximately $4.8 million in claims for supposed hospice care.
Insurance for all could be on the ballot in several states in November
A new group is pushing to get health care for all on state ballots across the country. One Payer States seeks high-quality, cost-effective universal health care for all at the state level. The strategy is to get the proposal on ballots in 10 states on the same election day in November, T.R. Reid told CPR. The new measure would allow adults up to the age of 65 to buy health insurance from a state agency. Seniors would stay on Medicare. People would then have the choice to purchase insurance from a private insurer if they wish, but advocates say a new state health program would be less expensive.
HHS to wind down mRNA vaccine development
The Department of Health and Human Services this week announced it would wind down its mRNA vaccine development activities under the Biomedical Advanced Research and Development Authority (BARDA). HHS said the decision follows a comprehensive review of mRNA-related investments initiated during the COVID-19 public health emergency. The wind-down will include terminations of contracts, descoping of mRNA-related work in existing contracts, and rejection or cancellation of multiple pre-award solicitations. Going forward, BARDA will focus on platforms with stronger safety records and transparent clinical and manufacturing data practices.