Faris Flournoy is the CEO of Flournoy Health Systems, a home health provider serving Georgia and Indiana.

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Alexis Kayser

By Alexis Kayser

Healthcare Editor

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This is a preview of the May 28 edition of Access Health—Tap here to get this newsletter delivered straight to your inbox on Thursday mornings.

Good morning. We’ve had a string of spring-like days here in Chicago—good news for those of you traveling in for ASCO next week!—so I’ve been spending more time outside.

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My home office window overlooks the Lakefront Trail, and throughout the day I watch a steady stream of cyclists, kayakers, walkers and joggers pass by. Most afternoons, I feel the pull to join them.

It’s a very different feeling from the one I had during my winter movie marathons, when nearly every commercial break seemed to feature a GLP-1 ad. This week, I found myself interrogating why one message feels motivating and the other unsettling, even irritating. Aren’t they both public displays aimed at improving health?

There are obvious benefits to exercise, especially outdoors. But there’s also growing evidence that GLP-1 receptor agonists may improve more than weight-related outcomes, with early studies suggesting potential effects on depression, addiction and other chronic conditions.

I don’t think it’s guilt, either. The marathon-training crowd starts running at 5 a.m. sharp, and I’m perfectly content watching them from my window with a cup of coffee.

I think it comes down to certainty. When I decide to go for a run, I know what I’m signing up for. Aside from the occasional rolled ankle or broken hair tie, it’s hard to regret that decision.

With GLP-1 drugs, the picture is murkier. The clinical promise is enormous, but so are the unanswered questions. And there are still so many questions: around long-term costs, coverage, outcomes and sustainability for all three. That uncertainty is what nags at me, not the ads themselves.

If you’re longing for a similar clarity around GLP-1s' impact—on both patients and the health care industry at large—I invite you to join us on June 9 for Newsweek’s next Health Care Webinar, “Will GLP-1s Ease or Escalate Health Care Costs?”

We’ve convened an expert panel with leaders from WEX, Lilly, the Obesity Medicine Association and Enara Health to discuss the tension between anticipated downstream savings and current costs; drug supply and patient demand; and what the balance (or lack thereof) will mean for the U.S. health care system.

I can’t guarantee that we’ll predict the future, but we hope you’ll leave with what you need to plan for the future. Click here for more info and to register. I hope to see you there!

In Other News

Major health care headlines from the week

Pulse Check

Executive perspectives on key industry issues

Faris Flournoy is the CEO of Flournoy Health Systems, a home health provider serving Georgia and Indiana.

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Two weeks ago, we covered CMS’ decision to pause new Medicare enrollment for hospice and home health agencies as part of the Trump Administration’s anti-fraud crackdown. (If you missed that edition, you can read it here.)

That announcement concerned health care providers across the country who are preparing for the 65+ population to boom. With more seniors entering the medical system and hospital inpatient units packed to the brim, hospice and home health agencies are critical to care sustainability.

I sat down with Faris Flournoy, CEO of Flournoy Health Systems, to learn more about what home health providers are experiencing right now.

Flournoy Health Systems is the management arm of Primecare Home Care Services, a family business that began after Flournoy and his brothers witnessed the need firsthand. His aging grandmother lived in the small, rural town of Esther, South Carolina, and caregiving services were tough to locate. When Flournoy’s grandmother was diagnosed with dementia, his mother—a schoolteacher and single parent—became her caregiver.

“Thus, the children, we became family caregivers as well,” Flournoy told me. “We had to go through and navigate the system of home health care, private duty care, finding physicians…all the things you typically need to age in place. It was very new to us.”

After serving in law enforcement and the Air Force, Flournoy returned to the health system in 2010 to provide the types of services that his family could have benefitted from: hospice and private duty home care. Currently, their network spans Georgia and Indiana.

Throughout our conversation, Flournoy painted a picture of a home care system that does, indeed, have bad actors. But it doesn’t have the resources to weed them out at scale, he said—and he fears that punishing entire agencies for the actions of a few will leave patients stranded.

Find a portion of our interview below.

Editor’s Note: Responses have been lightly edited for length and clarity.

What was your initial reaction to the administration's decision to pause new hospice and home health provider enrollment?

My initial reaction was, “Oh my gosh, they're responding to a shiny object.”

I see the impact of home health and hospice services day in and day out, and I do recognize that there are bad actors in everything. We have bad actors in the military; there are bad actors in every industry. Managing to that three to 10 percent [an estimate of all Medicaid spending that is estimated to come from fraud and improper payments] can be detrimental to care access, especially in rural communities.

How widespread is fraud in the hospice and home health business, from your perspective?

Fraud is there, and fraud can be concentrated in the home health care and hospice fields. There are times when an individual is motivated more by financials than [by providing] quality and compassionate care, but overall that is not running rampant within the industry.

Georgia Attorney General Chris Carr had a “statewide Medicaid fraud takedown” this month, and our company, Primecare Home Care Services, was listed in his report. There was one family caregiver that was part of our organization who committed fraud. She was going through the billing process fictitiously, stating that she was providing services for her loved one when [that loved one] was no longer under her care.*

We did everything right: we have all the checks and balances in place, we have electronic visit verification, we have documentation. But we can't go through every door in a home health setting to confirm that this person is there every time. Even with the barriers and the parameters we put in place, there's still potential fraud.

What we do [in response] is, we screen a little bit harder. We’re introducing more technologies to go through those checkpoints and mitigate fraud.

Yes, there are bad actors, but there are also solid individuals that truly care about the quality of care, the access to Medicaid and Medicare, and we're fighting for that. The response to [fraud should be] to go through and prosecute those bad actors, and hold high standards for those good providers that are providing value to the community.

Do you feel that the federal or state governments could be doing more to support this vetting process for hospice and home health providers?

I think that they should be upping the bar. Right now, you don't have to be clinical to run or own a hospice or home health care company. You have to be business-oriented. That’s why I love surveys and audits, because those accreditations ensure that we're meeting the standards for the federal government or the state Medicaid program. Those things right there, they don't scare away providers that are compliant, providers that are focused on quality care.

[Stricter accreditation standards] do put the hairs on the back of those individuals that are not in compliance.

But the states are stretched. They don't have enough individuals to survey providers. In the state of Georgia, in private duty home care Medicaid waiver programs alone, there are over 300 providers. And at that point, what can surveyors do in only 365 days a year? It’s impossible.

So technology has to come in place [to help]. I'm not against surveys, but I'm for them for the right action: not for penalization, but for upholding high standards.

Tell me about the workforce situation in your business. Is the supply of home health workers adequate to meet the demand for their services?

No. Post-COVID, the home health field lost an incredible workforce: RNs, CNAs, personal care aides. We lost them, and they're not coming back. They're going to higher-paid jobs, because it's more competitive now. Even medical doctors are getting approached by venture capitalists or PE firms.

What happens is—especially in rural communities—access to care is diminished. And that is exactly what we're seeing. Our workforces are being diminished due to other early employment opportunities. Access to care is being diminished because individuals are not flocking to rural communities, they're flocking to metropolitan areas with higher paying jobs.

That's why some states have introduced programs such as family caregiving, which allows for family members to fill in that gap. Is there an opportunity for fraud here? Absolutely. But there's also opportunity [for families] to keep their loved ones out of a nursing home, which costs the state tens of thousands of dollars per year. There's an opportunity for that family member to create more lasting memories with their loved one. There's an opportunity for quality care.

I don't think we should lower the government standards. I think we should enforce the standards, and then those individuals that are not upholding those standards [should be subject to] corrective action plans and weeded out.

Does this action from HHS impact your strategy moving forward?

It doesn't impact us on the hospice side as a licensed provider. Some companies have aspirations of growing and expanding their organization, and their expansion plans will be capsized, at least for the moment. Those individuals that are becoming new providers will also be impacted.

But in private duty home care, which is a large portion of our business, it’s typical that where the federal government goes, the state will follow. What I’m expecting—and already seeing in Georgia—is for state governments to mimic exactly what the federal government is doing. If the federal government places a moratorium on hospice and home health, the state administration will probably start enforcing more strict measures.

That's where I see access to quality care [being] diminished down the line.

Got it. Do you see any benefit to the administration's decision to halt new providers from entering the marketplace?

Our aging population is growing at such a rapid rate. We're entering this “silver tsunami,” where Baby Boomers are retiring like no other. Over the next few years, we have to go through and position a system that's going to support our next generation, our next retirees.

[This could be] a deliberate, intentional strategic pause to go through and see where the foundation is at. If it's cracked, we can go through and seal the gaps. If it's totally broken, we rebuild.

So the only benefit I see right now is, before we get inundated with all these Baby Boomers retiring and the care needs reaching capacity, this is an opportunity for providers and the federal government to partner together—evaluate those providers that are providing great quality care, see what those attributes are, understand the intention or the overall goal for these moratoriums and see how we align.

Is the goal just to go through and focus in on a few states that are shiny objects, like California and Minnesota? Or is it to go through and look at the rest of the United States and say, “Hey, we're not seeing that same thing down here.” This is an opportunity to reset, if that's the goal for the moratorium.

[*Editor’s Note: Newsweek confirmed that the family caregiver referenced is no longer serving through Primecare Home Care. The company provided the following statement expanding on additional safeguards implemented after the incident:

“As part of our ongoing commitment to Medicaid program integrity, we are implementing enhanced technology-based safeguards, including (but not limited to) location-based visit verification. This system validates that a caregiver is physically present at the approved service location. If a caregiver’s location does not match, the system prevents the clock-in and directs them to contact the office for a formal review.

This additional checkpoint ensures visits are fully validated before they are documented and billed, preventing inaccurate records or billing for unserved visits. It also allows our team to catch and address potential discrepancies much faster. While technology cannot eliminate every risk, these safeguards improve accountability, strengthen oversight, and support responsible and forward-thinking Medicaid compliance to best serve our clients and partners at DCH.”]

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This is a preview of the May 28 edition of Access Health—Tap here to get this newsletter delivered straight to your inbox on Thursday mornings.

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