Medicare Advantage was established as part of the Balanced Budget Act of 1997 passed by the 105th United States Congress and signed into law by then President Clinton.  It was originally named Medicare+Choice, and was renamed Medicare Advantage in 2003.  There are approximately 1,000 Medicare Advantage plans which enrolled 3.7 million people in 2025; about half of all Medicare recipients:

https://rollcall.com/2026/04/02/senate-democrats-call-on-cms-to-rein-in-medicare-advantage-abuses/

Senate Democrats call on CMS to rein in Medicare Advantage abuses
Senators urge CMS to shore up the program, rather than enroll more individuals in it
By Ariel Cohen - April 2, 2026

A group of Democratic senators led by Elizabeth Warren is pushing the Centers for Medicare and Medicaid Services to rein in abuses from Medicare Advantage insurers as the Trump administration considers a policy that would enroll more seniors in the program.

The senators allege that Medicare Advantage is rife with waste, fraud and abuse, and CMS should focus on shoring up the program, rather than enrolling more individuals in it. They argue CMS should do so by adopting the congressional Medicare advisers’ recommendations to rein in the program.

“CMS must do more to preserve the Medicare program’s mission of providing older adults and people with disabilities with affordable, high-quality health care,” the senators wrote in a Wednesday letter to CMS Administrator Mehmet Oz, referring to the 2027 proposed payment rate for Medicare Advantage plans.

Lawmakers signing the letter in addition to Warren, D-Mass., include Cory Booker, D-N.J., Richard Blumenthal, D-Conn., Richard J. Durbin, D-Ill., Edward J. Markey, D-Mass., Jeff Merkley, D-Ore., Bernie Sanders, I-Vt., and Tina Smith, D-Minn.

The Medicare Payment Advisory Commission, often referred to as MedPAC, offered recommendations that included excluding diagnoses from all chart reviews and health risk assessments from risk scores and addressing the favorable selection of healthier patients that leads to overpayments.

The Democrats also say that CMS should protect patients from Medicare Advantage prior-authorization denials, strengthen network adequacy requirements and examine whether plans are evading medical-loss ratio requirements by buying up providers.

They say that changes are essential in light of the Trump administration’s floated policy to enroll more Americans in Medicare Advantage. Last month, Stat reported that Medicare Director Chris Klomp said that CMS is considering models that would automatically enroll beneficiaries into Medicare Advantage, and individuals could opt into a different service arrangement.

“Aside from the numerous financial problems and patient care concerns such a proposal raises, it also very likely violates the requirements for any Centers for Medicare and Medicaid Services Innovation Center models to reduce taxpayer spending,” the Democrats wrote of Klomp’s proposal.

Shifting all seniors to Medicare Advantage as a default option was first proposed in The Heritage Foundation’s Project 2025 as part of a larger effort to encourage more competition between Medicare Advantage and private plans.

But Republicans on Capitol Hill also support some changes to the program. Senate Health, Education, Labor and Pensions Chair Bill Cassidy, R-La., last year introduced legislation aimed at reducing overpayments on care in the program.

Medicare Advantage enrollees face more delays when seeking care compared to seniors on traditional Medicare because of more prior-authorization requirements and restricted physician networks. The average enrollee has access to “just under half of all physicians available to traditional Medicare beneficiaries in their area,” according to KFF, and Medicare Advantage insurers denied around 4.1 million prior-authorization requests in 2024.

Medicare Advantage insurers received nearly 53 million prior-authorization requests in 2025. By contrast, traditional Medicare beneficiaries submitted just 625,000 prior-authorization requests that year, according to KFF.

The lawmakers say CMS should take more steps to strengthen network adequacy requirements and penalize insurers who are out of compliance, as well as protect Medicare Advantage enrollees from inappropriate delays to care.

MedPAC estimates that overpayments to Medicare Advantage could reach $76 billion in 2026 and $1.3 trillion over the next decade, all while seniors enrolled in the program receive worse care compared to traditional Medicare. The Democrats say that by overlooking the fact that Medicare Advantage enrollees are typically healthier than the average Medicare enrollee, the federal government systematically overpredicts the program’s spending, leading to overpayment.

Medicare Advantage insurers are increasingly owned by large health care conglomerates that also own medical providers, and critics say that when the same entity both pays for and provides care, it creates anti-competitive behavior.

In their letter, the Democrats also allege that many Medicare Advantage insurers might be using profit-shifting strategies to evade the caps on what percentage of patients’ premium dollars they can spend on profits and administrative costs.

They want CMS to crack down on these profit-shifting practices by collecting better ownership data of plans and providers, as well as establishing benchmarks for common health care services.

“As Americans struggle to keep up with rising health care costs, insurers continue to rake in billions in overpayments, abusing taxpayer dollars, while inappropriately obstructing enrollees from accessing medical care,” they wrote. “We urge CMS to turn its focus to the legitimate fraud, waste, and abuse in and address the program’s longstanding problems that prevent seniors and people with disabilities from receiving medically necessary care.”

https://hoodline.com/2026/04/msu-shakes-up-med-schools-in-big-bet-on-detroit-grand-rapids/

MSU Shakes Up Med Schools in Big Bet on Detroit, Grand Rapids
By Marcus Taylor - April 3, 2026

Michigan State University is pulling its two medical schools under one leadership roof and doubling down on Grand Rapids and Detroit as its main research and clinical hubs. The overhaul is meant to better align the MD and DO degree tracks, centralize administration, and widen access to clinical rotations and translational research sites across Michigan. University leaders say the shift is about becoming a stronger partner to large health systems and a tougher contender for grants and private investment.

As reported by Crain's Detroit Business, the change folds the College of Human Medicine and the College of Osteopathic Medicine into a more coordinated structure that highlights MSU's footprint in the state's two biggest cities. Crain's describes the move as both an administrative consolidation and a strategic wager on Detroit and Grand Rapids as growth engines, with centralized back-office work paired with an expansion of clinical sites and research partnerships.

MSU is branding the shift under its "One Team, One Health" strategy, which explores a "One College of Medicine, Two degree pathways" model that keeps MD and DO identities intact while syncing curriculum oversight, research priorities, and institutional strategy, according to MSU. The planning materials outline task forces on accreditation, college structure, and research that will recommend a path forward, and MSU says town halls and community conversations will continue as the work moves along.

Anchors in Grand Rapids and Detroit

On the west side, Grand Rapids remains the key anchor. The College of Human Medicine is based at the Secchia Center on the Medical Mile, which MSU touts as a hub for preclinical education, simulation, and growing research activity, according to MSU College of Human Medicine. In Detroit, MSU's clinical integration has been speeding up through a multi-year partnership with Henry Ford Health that features shared services, an electronic health record migration, and plans for a Detroit research center, according to a Henry Ford Health press release. Together, the two hubs give MSU a stronger foothold in both of Michigan's largest health care markets.

Why Students, Hospital Partners and Patients Should Care

University officials say the unified approach could open up more clinical rotation slots for students and smooth out recruitment pipelines for hospitals, a core part of MSU's broader strategic pitch highlighted by MSUToday. Hospital systems could see tighter clinical networks and shared hiring pipelines, while researchers are eyeing a combined college as a way to boost MSU's odds for federal grants and philanthropic funding. At the same time, hospital leaders, faculty, and students are waiting to see how governance, budgets, and the split of clinical revenue and overhead are sorted out.

Accreditation and governance are still unresolved. The university has created an accreditation task force and promised more analysis before landing on a final structure, according to MSU. Any change to how the MD and DO programs are run will need careful review from accrediting bodies and campus stakeholders, and MSU has signaled there will be more community conversations in the months ahead.

For now, MSU is stressing that both degree pathways will remain in place and that the goal is to amplify its statewide presence, not close campuses. The finer points, including timelines, projected savings, and what all of this means for day-to-day clinical placements, are expected to surface as task forces report back and more town halls take place.

https://www.justice.gov/usao-cdca/pr/8-arrested-health-care-fraud-takedown-including-owners-hospices-billed-taxpayers

8 Arrested in Health Care Fraud Takedown, Including Owners of Hospices that Billed Taxpayers Millions of Dollars to Serve the ‘Dying’
Thursday, April 2, 2026; Updated April 3, 2026
For Immediate Release
U.S. Attorney's Office, Central District of California Press Release

More Than $50 Million in Intended Health Care Fraud Losses Charged

LOS ANGELES – In coordination with the Vice President’s Task Force to Eliminate Fraud, eight defendants, including three nurses, a chiropractor, and a purported psychologist, have been arrested on federal charges that they schemed to defraud the nation’s health care system out of more than $50 million – including by running sham hospice care facilities that bilked Medicare by using people without terminal illnesses as beneficiaries, the Justice Department announced today.

Six of the defendants arrested today are expected to make their initial appearances this afternoon in United States District Court in downtown Los Angeles. One defendant is expected to make his initial appearance in U.S. District Court in Idaho.

“We are enforcing a zero-tolerance policy for criminals who defraud American taxpayers,” said First Assistant United States Attorney Bill Essayli. “The defendants arrested this morning who are charged with stealing millions of dollars of health care benefits got caught and now face years in federal prison.”

“The Southern California region is a high-risk environment for hospice-related and many other forms of health care fraud,” said Akil Davis, the Assistant Director in Charge of the FBI’s Los Angeles Field Office. “The United States loses hundreds of billions of dollars annually to healthcare fraud at the expense of all American taxpayers, whose benefits decrease as premiums, co-payments and taxes grow. Our aim is to reverse that trend with ‘Operation Never Say Die’ and others like it.”

“The defendants charged today allegedly turned hospice care into a cash producing operation, resulting in more than $50 million in losses to taxpayers. The magnitude of the losses underscores a deliberate abuse of the authority and trust afforded to health care providers,” said Inspector General T. March Bell of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). “Today’s takedown reflects HHS-OIG’s commitment to deploy every tool at our disposal, and collaborate with our law enforcement partners, to dismantle hospice operations built on deception. Anyone who seeks to weaponize hospice care to bilk Medicare should expect to be held accountable.”

“Today’s arrests are another decisive strike in our war on fraud,” said U.S. Department of Labor Inspector General Anthony P. D’Esposito. “My office is relentlessly pursuing those who target union benefit plans and exploit employee healthcare programs for personal gain. Working side-by-side with the FBI, the Department of Labor’s Employee Benefits Security Administration, and our law-enforcement partners, we are aggressively dismantling fraud schemes and taking down those who exploit American workers. Let this be a warning: If you steal from workers or taxpayers, your time is up. We will find you, investigate you, and hold you accountable.”

“When employee benefit plans become targets for fraud, it’s not just the plans that are hurt – everyday working Americans who earned those benefits honestly, their families, and the communities they live in are hurt,” said Robert Prunty, Acting Regional Director U.S. Department of Labor Employee Benefits Security Administration’s Los Angeles Regional Office. “In the Trump Administration, we will relentlessly seek out fraud and ensure those responsible are brought to justice.”

“Health care fraud undermines federal programs, threatens public trust, diverts resources away from legitimate patient care, and is a calculated attack on programs meant to protect the vulnerable,” said Tyler Hatcher, Special Agent in Charge, IRS‑CI Los Angeles Field Office. “The enforcement actions taken today demonstrate IRS‑CI’s commitment to uncovering the financial lies behind these schemes and holding accountable those who profit at the expense of taxpayers and patients. Our agents will continue to work alongside our law‑enforcement partners to protect the integrity of our healthcare system and ensure that those who abuse it are brought to justice.”

MEDICARE HOSPICE CARE FRAUD

USA v. Minerd

Lolita Beronilla Minerd, 65, a.k.a. “Lolita Beronilla Rice,” of Anaheim, a licensed vocational nurse, was arrested today on a federal criminal complaint charging her with health care fraud.

According to court documents, Minerd owned and operated the Artesia-based Topanga Hospice Care Inc. From July 2020 to April 2025, Minerd used this company to submit more than $9,174,117 in fraudulent hospice claims to Medicare, which paid more than $8,510,448 on these claims.

Through Topanga, Minerd billed Medicare for hospice services for beneficiaries who were not terminally ill. Numerous beneficiaries had common addresses and lived far from the facility, which is consistent with being recruited by marketers. The investigation further revealed that Minerd paid kickbacks to beneficiaries and marketers for the referral of purported hospice patients to her company.

One beneficiary couple was approached at a market about signing up and then were visited at home by Minerd and three other Topanga employees, who promised them if they signed up everything would be free, and they each would receive $300 per month. The money was delivered in an envelope in cash: $600 per month for six months. Neither beneficiary stated they had a terminal illness, which their physician confirmed. The couple also reported receiving unneeded items such as nutritional shakes, non-prescription vitamins, and wheelchairs.

Topanga had a non-death discharge rate of approximately 85%, nearly five times the national average of 17.2% from 2021.

The FBI is investigating this matter along with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).

Assistant United States Attorney Alexandra M. Michael of the Major Frauds Section is prosecuting this case.

USA v. Gill, et al.

Gladwin Gill, a 66-year-old purported psychologist, and his wife, Amelou Gill, a 70-year-old registered nurse, both of Covina, were arrested today on a federal criminal complaint charging them with health care fraud.

According to an affidavit filed with the complaint, the Gills owned and operated the Glendale-based 626 Hospice Inc., which did business as St. Francis Palliative Care.

The Gills allegedly schemed to defraud Medicare by paying illegal kickbacks for the referral of patients who were not dying. The Gills also submitted more than $5.2 million in fraudulent claims to Medicare for hospice services that either were not medically necessary or were not provided. Medicare paid the Gills more than $4 million on these fraudulent claims.

They then laundered the scheme’s proceeds and spent their ill-gotten gains on personal expenses such as mortgage payments, car payments, international flights, restaurants, and personal bills.

The Gills are expected to make their initial appearance this afternoon in U.S. District Court in downtown Los Angeles.

HHS-OIG, the FBI, IRS Criminal Investigation, and the Food and Drug Administration are investigating this matter with assistance from United States Trustee, Region 16, Los Angeles Field Office.

Assistant United States Attorney David Y. Pi of the Major Frauds Section is prosecuting this case.

USA v. Palma, et al.

Nita Almuete Paddit Palma, 76, a thrice-convicted health care fraudster now incarcerated at a federal prison in Seattle, and her husband, Adolfo Cezar Catbagan, 68, of Glendale, are charged in an 11-count indictment with operating at least three fraudulent hospice care facilities – including while Palma was free on bond awaiting a hospice fraud trial. Law enforcement arrested Catbagan this morning.

Palma, who is a lawful permanent resident from the Philippines, and Catbagan are charged in an indictment with one count of conspiracy to commit wire fraud and health care fraud and 10 counts of health care fraud.

According to the indictment, from June 2022 to April 2024, Palma and Catbagan opened three Glendale-based hospice care facilities despite Palma being legally barred from doing so: One Up Hospice Care Inc., Rosewood Hospice and Palliative Care Inc., and Advance Hospice and Palliative Care Inc.

Catbagan was named as the nominal owner and CEO of the three hospices when Palma in fact owned and exercised operating control of them – despite her exclusion – so Medicare would not deny the companies’ claims. The defendants submitted false claims to Medicare for beneficiaries who were not terminally ill and the physicians supposedly providing hospice services did not treat the patients.

Palma and Catbagan submitted at least $4.8 million in fraudulent claims through these companies, resulting in Medicare payments of at least $4.2 million.

HHS-OIG and the FBI are investigating this matter.

Assistant United States Attorneys Andrew M. Roach and Roger A. Hsieh of the Major Frauds Section are prosecuting this case. Assistant United States Attorney Alexander Su of the Asset Forfeiture and Recovery Section is handling asset forfeiture matters for this case.

USA v. Tindimobuna

Evelyn Tindimobuna, 51, a licensed vocational nurse from Chatsworth, is charged in a federal criminal complaint with health care fraud. According to an affidavit filed with the complaint, from January 2022 to September 2025, Tindimobuna used the Tarzana-based Comfort Choice Hospice Inc. to submit to Medicare hundreds of fraudulent claims for purported hospice services to dozens of beneficiaries. For those claims, Comfort Choice sought more than $3.8 million, of which Medicare paid approximately $3.4 million.

For example, in November 2022, Comfort Choice submitted a claim to Medicare in the amount of $7,021, for reimbursement of hospice services for a beneficiary. Law enforcement later interviewed this beneficiary and other Comfort Choice patients who said they were not terminally ill, a requirement to qualify for hospice care.

Tindimobuna allegedly also paid kickbacks to marketers for their referral of hospice patients to Comfort Choice in violation of the Anti-Kickback Statute.

HHS-OIG is investigating this matter.

Special Assistant United States Attorney Yervant P. Hagopian of the Major Frauds Section is prosecuting this case.

USA v. Lauritzen

Ivan Verne Lauritzen, 50, of Simi Valley, was arrested Tuesday on a federal criminal complaint charging him with health care fraud. According to court documents, Lauritzen was the CEO and CFO of the Simi Valley-based Valley Pacific Hospice Inc., whose Medicare enrollment was revoked in August 2024.

In 2022, the live discharge rate of Valley Pacific patients was more than 75%, vastly higher than the national average that year of approximately 17%. Based on an audit examining 18 Valley Pacific Medicare claims from August 2023 to March 2024, CMS determined the company had a pattern and practice of submitting claims that failed to meet Medicare’s hospice standards and requirements. To facilitate this fraud, Lauritzen forged the signature of at least one physician on the Medicare enrollment forms.

During the alleged scheme, Valley Pacific billed Medicare more than $580,000 and was paid more than $526,000.

Lauritzen made his initial appearance Tuesday and was ordered released on $10,000 bond. His arraignment is scheduled for April 27.

HHS-OIG is investigating this matter.

Assistant United States Attorney Neil P. Thakor of the Major Crimes Section is prosecuting this case.

PRIVATE HEALTH CARE PLAN FRAUD

USA v. Aulava-Moala, et al.

Four defendants with South Bay ties – one of them a licensed chiropractor – have been charged in a two-count information with conspiracy to commit health care fraud and wire fraud in connection with a $19 million scheme to defraud a labor union’s health plan via false claims for chiropractic services and physical therapy that weren’t needed or never provided.

The defendants charged are:

• Tolu Aulava-Moala, 51, of Carson, who was the director of the facilities;
• John Nicola, 77, of El Segundo, a licensed chiropractor;
• Crysta Richter, 40, of Torrance, who owned a medical billing company; and
• John Keohuloa, 49, of Long Beach.

These defendants will be summonsed into Los Angeles federal court and are expected to make their initial appearances in the coming weeks.

According to court documents, from January 2010 to September 2023, they fraudulently submitted at least $19,005,463 in claims to International Longshore and Warehouse Union Pacific Maritime Association and other private health insurers on behalf of several chiropractic and physical therapy service companies: Ohana Wellness Center, Ohana Management Corp., and R3New Wellness – all based in Carson – and the Huntington Beach-based One Life Acupuncture APC.

Aulava-Moala and Keohuloa induced beneficiaries to visit clinics to receive medically unnecessary services, such as massages or endoscopies, in exchange for kickback payments. Nicola knowingly created fake client notes for beneficiaries, and Aulava-Moala, Nicola, and Richter submitted false and fraudulent claims to health insurers for reimbursement for medical services.

In August 2022, the former owner of the Ohana companies testified under oath at a civil trial that the companies falsified patient chart notes and billed claims under chiropractors’ names and insurance numbers without their knowledge. A state court later that month found the Ohana companies liable for the fraud scheme.

In addition, from March 2016 to June 2023, Aulava-Moala and Keohuloa conspired to submit approximately $700,000 in fraudulent receipts for a charity donation program operated by a Los Angeles-based oil refinery for which the company paid at least $500,000.

The FBI, the U.S. Department of Labor Office of Inspector General (DOL-OIG), and the U.S. Department of Labor – Employee Benefits Security Administration are investigating this matter with assistance from Homeland Security Investigations (HSI) and the United States Secret Service.

Assistant United States Attorney Jason C. Pang of the Transnational Organized Crime Section is prosecuting this case.

USA v. Cartmell; USA v. Surace

Gregory Cartmell, 62, of Coeur D’Alene, Idaho, a licensed chiropractor, was arrested today on a four-count indictment charging him with two counts of health care fraud and two counts of aggravated identity theft. He is expected to make his initial appearance today in U.S. District Court for the District of Idaho. He will be arraigned in Los Angeles in the coming weeks.

According to the indictment, from December 2018 to November 2022, Cartmell submitted approximately $9.14 million in fraudulent claims to the ILWU-PMA health plan for chiropractic services – including for services not rendered – and received approximately $6.43 million in payment from the union’s health plan, which had terminated him from the plan in December 2020.

To circumvent his termination, Cartmell arranged with a co-conspirator – Vincent Surace, 87, of McKinney, Texas – to bill ILWU-PMA’s health plan under the co-conspirator’s name and identification number. In exchange for allowing his name and ID number to be used in the scheme, Cartmell paid Surace a portion of the proceeds the union’s plan paid for the fraudulent claims.

Surace is charged via information with one count of conspiracy to commit health care fraud. He will be summonsed to Los Angeles federal court in the coming weeks.

The FBI, the U.S. Department of Labor Office of Inspector General (DOL-OIG), and the U.S. Department of Labor Employee Benefits Security Administration (DOL-EBSA) are investigating this matter.

Assistant United States Attorneys Jason C. Pang of the Transnational Organized Crime Section and William M. Larsen of the Criminal Appeals Section are prosecuting this case with assistance from Assistant United States Attorney Christopher C. Kendall of the Transnational Organized Crime Section.

USA v. Griffen

Sonia Griffen, 51, of Lakewood, was arrested today on a five-count indictment charging her with health care fraud. From April 2019 to May 2024, Griffen allegedly submitted nearly $5 million in fraudulent claims to ILWU-PMA’s health care plan through her wellness company, Bee Well Holistic Wellness Center, for purported chiropractic services given to union members, even though the plan had previously terminated Bee Well and barred it from submitting claims.

According to the indictment, to circumvent Bee Well’s termination from the ILWU-PMA plan and obtain payments, Griffen concealed Bee Well’s identity and involvement by arranging with two chiropractors to bill the plan under their names and at fictitious addresses. She also submitted false claims billing the plan for chiropractic services that were never rendered.

In total, Griffen submitted approximately $4.9 million in fraudulent claims to the ILWU-PMA plan, resulting in payments of approximately $2.5 million.

The FBI, the United States Department of Labor Office of Inspector General (DOL-OIG), and the Department of Labor – Employee Benefits Security Administration (DOL-EBSA) are investigating this matter.

Assistant United States Attorney Jing Yan of the General Crimes Section is prosecuting this case.

IMMIGRATION HEALTH CARE FRAUD

USA v. Ko

Young Joo Ko, 59, of East Hollywood and a lawful permanent resident from South Korea, was arrested today on a federal criminal complaint charging her with fraud and misuse of visas, permits, and other documents.

According to an affidavit filed with the complaint, Ko engaged in a medical fraud scheme exploiting the green card application process by creating fraudulent immigration documents. Civil surgeons designated by U.S. Citizenship and Immigration Services (USCIS) and operating in the Los Angeles area did not examine green card applicants as required by law.

Instead, Ko – for a fee – fraudulently prepared the required forms by presenting herself as a nurse or doctor and indicating false compliance with medical examination requirements necessary for immigration applicants to register permanent residence or adjust their immigration status.

If convicted, Ko would face a statutory maximum sentence of 10 years in federal prison.

HSI, IRS Criminal Investigation, and USCIS are investigating this matter.

Assistant United States Attorney Brenda N. Galván of the General Crimes Section is prosecuting this case.

Health care fraud-related charges in these cases carry a statutory maximum sentence of 10 years in federal prison. Wire fraud is punishable by up to 20 years in federal prison. Aggravated identity theft carries a mandatory two-year consecutive prison sentence.

Complaints and indictments contain allegations that a defendant has committed a crime. Every defendant is presumed to be innocent until and unless proven guilty in court.

Contact
Ciaran McEvoy
Public Information Officer
ciaran.mcevoy@usdoj.gov
(213) 894-4465

https://michiganadvance.com/2026/04/04/repub/its-a-safe-space-mobile-midwifery-clinics-meet-patients-where-they-are/

‘It’s a safe space’: Mobile midwifery clinics meet patients where they are
By Nada Hassanein - April 4, 2026

MIAMI — Midwife Sheila Simms Watson leaned to gently press on the pregnant woman’s belly. Me’Asia Taylor lay on a bed fitted with tie-dyed purple printed sheets in the corner of the RV.

Far from a typical camper, this RV houses a mobile midwifery clinic for prenatal, postpartum and women’s general health care.

“Roll when you’re getting up, and we can help you. You can sit there for a moment, all right, so you’re not lightheaded, not dizzy,” said Watson, whom patients and doulas call “Mama Sheila.”

Calm and slow, led by Watson’s soothing and attentive demeanor, the appointments are unrushed.

Run by the Southern Birth Justice Network, the mobile midwifery clinic brings care to majority-Black and Latino neighborhoods across Miami-Dade County several times a month. The clinic aims to offer a more relaxed setting, where women are comfortable and heard, their cultures are integrated, and they can connect with doulas from diverse backgrounds.

On the half-moon bench inside the RV, Watson, a doula and a midwife in training sit with patients. They take blood pressures and draw blood. They ask the women about their lives: How is their mental health and sleep? Do they have support at home? Do they want to give birth at a hospital or birth center with a midwife?

Taylor said pre-eclampsia, a dangerous pregnancy condition, runs in her family. She wanted to make sure she had space and time to express her concerns about her first pregnancy.

Taylor said she wants a midwife for her delivery. Many women of color have reported feeling marginalized or dismissed in medical settings. “I’ve just seen too many people have bad experiences,” Taylor told Watson.

The U.S. has markedly higher maternal mortality and infant mortality rates compared with other high-income countries, and women and babies of color fare the worst. Black women’s maternal death rates are three times higher than those of white women, and American Indian and Alaska Native women’s rates are twice that of white women. Researchers point to implicit bias, less regular access to prenatal care and higher rates of poverty.

OB-GYN shortages and labor and delivery units closing continue to make getting care harder. Last year, more than two dozen hospital labor and delivery units across the nation closed, including some in South Florida. And pregnant patients living miles away, or feeling uneasy about going to the doctor, may even forgo care.

Midwives can help fill gaps, maternal health equity advocates say, and mobile clinics can meet patients where they are.

“It really helps to disrupt this idea that patients must navigate these complex systems to receive care — and instead, (mobile midwifery) reimagines care as something that should be responsive to the needs of patients and should be community-centered,” said Tufts University professor and maternal health scholar Ndidiamaka Amutah-Onukagha.

But mobile units are not as common for midwifery as they are for other areas of care, such as dentistry or family medicine, the American College of Nurse-Midwives told Stateline. Other prenatal mobile outreach efforts in the state include an OB-GYN-run mobile unit by the University of Florida that serves areas around north-central Alachua County and an operation called The Midwife Bus in Central Florida.

To increase access to care, maternal health advocates are also pushing states to change regulations that restrict midwifery. The American College of Nurse-Midwives recently filed a lawsuit against Mississippi for requiring nurse-midwives to have agreements with physicians in order to practice. This week, Jamarah Amani, a midwife and the executive director of the Southern Birth Justice Network, joined other plaintiffs in filing a lawsuit against Georgia over its restrictions. But supporters of the rules say they are meant to protect patients and foster communication between clinicians.

Offering culturally centered prenatal care that women are more inclined to use can help address inequities in maternal health, Amani said. The group trains doulas, offers telehealth, provides referrals such as to mental health therapists, and advocates for equitable policies across the South.

Most of the mobile clinic’s clients — about 70% — are on Medicaid or uninsured, and the clinic is funded through federal and university grants, as well as donations.

“(Midwifery) presents like a luxury concierge-type of service,” Amani said. “Our goal is to really change that and to bring it back to the community in a very grassroots way.”

Preserving tradition

The Southern Birth Justice Network keeps a small drum on a table at a nearby booth. It represents the heartbeat, and ancestral reverence, Amani said. Drums are a universal language, and the instrument is meant to symbolize culture.

For doulas and many midwives like Amani and Watson, bringing their profession to communities today is the continuation of a significant part of Black American heritage.

Throughout history, Black midwives were venerated in their communities. Many practices were rooted in West African traditions. These midwives were the keepers of Black ancestral records, and delivered many white women’s babies. Enslaved women who were midwives traveled for deliveries. Some routes, long and traversed by foot, were dangerous in the deep rural South. During the Jim Crow era, Black Americans were denied care at hospitals or given inferior care.

“They only had protection if someone would send a carriage for them if they were going to deliver a white woman’s baby. But to care for the Black families, they often had to go in the middle of the night, alone,” Amani said. “We talk about the legacy of Black midwives as health care providers, but also as social pillars, as community leaders, as resistors of oppression.”

In the 20th century, medical institutions began to oppose midwifery, sometimes using racist and sexist campaigns to target the practice. They argued it was unhygienic and lobbied across states to dismantle midwifery. At the same time, while developing the field of obstetrics, doctors conducted gynecological experiments on Black women. The American College of Obstetricians and Gynecologists has acknowledged this history and said it’s committed to fighting racism and inequities.

Dr. Jamila Perritt, an OB-GYN and president and CEO of Physicians for Reproductive Health, said that in order to address structural barriers and close gaps, policies have to prioritize access to care, such as allowing midwives to expand their practices. Throughout the South especially, states still restrict midwives from practicing independently, despite widespread maternal health care deserts. She also pointed to research showing midwifery is associated with fewer C-sections, less preterm labor and better patient satisfaction.

“Expanding access to midwifery care, and expanding collaborations between physicians and midwives, only improves outcomes,” Perritt said.

Cultivating trust

On a recent breezy and brisk Saturday morning, the Southern Birth Justice Network’s midwives and doulas were stationed in the parking lot of the Freedom Lab, a local community center that hosts food and clothing distribution and a free urgent care center.

At the booth by the mobile clinic, under the shade of a royal-purple awning, meditation music, low-key and mellow, reverberated from a small speaker. There was a cooler filled with oranges, water and other snacks for the clinic’s pregnant patients.

“I’m going to keep giving you food. You need to eat enough,” one doula told a patient, handing her an orange and a liter of spring water.

Staff had surveys to help assess a new patient’s needs, and Florida-specific pamphlets on pregnant patients’ rights. The group is working on other state-specific guides for Louisiana, Massachusetts, Tennessee and Texas.

The table also held a portrait of the late midwife Ada “Becky” Sprouse, who started the mobile midwife clinic around 2008. She’d drive it to the city of Homestead, an agricultural hub in Miami-Dade County. There, she offered free midwifery care to migrant farmworkers, many of whom couldn’t afford care throughout their pregnancies.

Sprouse passed the clinic on to Amani, who relaunched the mobile unit and broadened the scope of the Southern Birth Justice Network.

Patients told Stateline trust was one of the main reasons they sought out the clinic. One patient said she spent 2 1/2 hours on public transit that day so that she could see the team.

For now, deliveries take place at hospitals or neighboring birth centers, where some of the group’s midwives also work. But the organization recently bought a building to open its own freestanding birth center, aiming for next year, along with a larger RV.

One patient, Isis Daaga, turned to Amani to deliver her other children after her first birth at a hospital. Despite the pressure she felt and her need to push during labor, Daaga recalled, hospital staff prevented her from delivering.

“They literally held my knees together,” Daaga said. “They were like, ‘the doctor’s not here yet,’ and the nurses were scared to deliver the baby.” In many hospitals, protocol is to wait for the doctor in case an emergency occurs.

By the time the doctor came, Daaga had a severe perineal tear, and she delivered the baby in one push. She had been in labor for 15 hours.

“I was in pain, I was upset,” said Daaga, a mental health therapist who is 35 weeks pregnant.

At the mobile clinic and with the midwives, Daaga said she feels supported.

“They make me feel the way I try to make my clients feel, like, it’s a safe space. You’re not judged here. I have a lot going on,” she said. “If I’m MIA or something, most of them will call and text me and (say), ‘Girl, you need to come in.’”

https://www.bls.gov/news.release/empsit.nr0.htm

Health care added 76,000 jobs in March. Employment in ambulatory health care services rose by 54,000, reflecting an increase of 35,000 in offices of physicians as workers returned from a strike. Employment also increased in hospitals (+15,000). Over the prior 12 months, health care had added an average of 29,000 jobs per month.

Go to the extensive charts and text at the hyperlink, above, for more information and data.  Table B-1. Employees on nonfarm payrolls by industry sector and selected industry detail tells the health care story:

https://www.bls.gov/news.release/empsit.t17.htm

https://www.whitehouse.gov/fact-sheets/2026/04/fact-sheet-president-donald-j-trump-bolsters-national-security-and-strengthens-u-s-supply-chains-by-imposing-tariffs-on-patented-pharmaceutical-products/

Fact Sheet: President Donald J. Trump Bolsters National Security and Strengthens U.S. Supply Chains by Imposing Tariffs on Patented Pharmaceutical Products
The White House
April 2, 2026

• President Trump imposed a 100% tariff on patented pharmaceutical products and ingredients.
• The tariffs will come into effect in 120 days for certain large companies, and 180 days for smaller companies.
• Trade Deal Countries:
• If a pharmaceutical product is from the European Union, Japan, Korea, or Switzerland and Liechtenstein, a 15% tariff will apply. If a pharmaceutical product is from the United Kingdom, a lower tariff will apply, subject to the recently concluded UK pharmaceutical agreement.Onshoring and pricing agreements:
• For companies that enter into Most Favored Nation (MFN) pricing agreements with the Department of Health and Human Services (HHS) and onshoring agreements with the Department of Commerce, a 0% tariff will apply through January 20, 2029. For companies that only enter into onshoring agreements with the Department of Commerce, a 20% tariff will apply.The Department of Commerce and HHS will provide pathways for companies to enter into onshoring and MFN pricing deals with the U.S. Government.
• Generic pharmaceuticals: Generic pharmaceutical products, biosimilars, and associated ingredients are not subject to tariffs at this time. This will be reassessed in one year.
• Specialty pharmaceutical products: Orphan drugs, drugs for animal health, and certain other specialty pharmaceutical products will be exempt, if they are from trade deal countries or meet an urgent public health need.
• The Proclamation establishes strong monitoring and enforcement mechanisms, including external audits and tariff increases on future and past imports.

• President Trump imposed these tariffs following an extensive investigation conducted by the Secretary of Commerce under Section 232 of the Trade Expansion Act of 1962, as amended, to determine the effects on national security of imports of pharmaceuticals, pharmaceutical ingredients, and related products.
• The investigation found that patented pharmaceuticals and associated pharmaceutical ingredients are being imported into the United States in such quantities and under such circumstances as to threaten to impair our national security.
• The impending Section 232 tariffs have already spurred approximately $400 billion in new investment commitments from U.S. and foreign pharmaceutical companies, which will be spent in the United States during President Trump’s current term in office.
• A self-sufficient domestic manufacturing and industrial base for pharmaceutical products is vital for the ability to support national defense requirements and public health.
• Despite being the world leader in research and development for most innovative pharmaceuticals, the U.S. is heavily reliant on imports, threatening to limit U.S. access to life-saving medications in the event of global supply chain disruption.

• In May 2025, President Trump signed an Executive Order to remove regulatory barriers and facilitate the restoration of a robust domestic manufacturing base for prescription drugs, including key ingredients and materials necessary to manufacture prescription drugs.
• In August 2025, President Trump signed an Executive Order to ensure American pharmaceutical supply chain resilience by filling the strategic active pharmaceutical ingredients reserve.
• President Trump’s Administration has launched Section 232 investigations in adjacent sectors such as personal protective equipment, medical consumables, and medical equipment and devices, as well as robotics. These investigations will help ensure that harmful imports in any strategic sector do not compromise national security.

The Centers for Disease Control and Prevention listed on Monday 27 types of testing that have been suspended.  Andrew Nixon, an HHS spokesman, called the pause temporary and attributed it to “a routine review to uphold our commitment to high quality laboratory testing.”  “We anticipate some of these tests will be available through CDC labs again in the coming weeks. In the meantime, CDC stands ready to support our state and local partners to access the public health testing they need.”

Go to the CDC ID Laboratories page to see the tests which have been suspended:

https://cdc.gov/infectious-diseases-labs/php/test-directory/index.html

Note that the CDC is in an interregnum.  Jay Bhattacharya, MD, PhD. is the current acting director of the Centers for Disease Control and Prevention (CDC) after Susan Monarez was canned.

https://s3.documentcloud.org/documents/27926757/cms-memorandum-on-dietary-guidelines.pdf

This memorandum reminds hospital providers of their obligations related to patient food and nutrition services. On January 7, 2026, HHS and USDA released the Dietary Guidelines for Americans, 2025–2030 (DGAs), which place heightened emphasis on diet quality — including limiting ultra-processed foods, sugar-sweetened beverages, refined carbohydrates, and added sugars, while prioritizing whole and minimally processed foods. These updates reflect the latest federal nutrition policy and are encouraged to be used to inform patient nutrition services and related hospital protocols. Given the scale of Medicare’s investment in inpatient care, CMS has a responsibility to ensure that hospital food and nutrition services support high-quality, evidence based care and improved health outcomes.

Hospitals must comply with Conditions of Participation at 42 CFR §482.28, including ensuring menus and diets meet individual patient nutritional needs in accordance with recognized dietary practices, qualified dietitian oversight, maintenance of a current therapeutic diet manual, and integration of dietary services into Quality Assessment and Performance Improvement (QAPI) processes. As consistent with 42 CFR §482.28 and CMS guidance, hospitals should review and revise food and nutrition service policies, standard menus, therapeutic diet protocols, and food procurement practices to align with the 2025–2030 DGAs.

Discussion:
Diet Quality and Health Outcomes

The United States spends approximately $5 trillion per year on health care. Ninety percent of those expenditures are on patients with chronic disease. Since Medicare represents approximately 40% of health care spending on chronic health conditions in the United States, the impact on American taxpayers and the Federal deficit is significant.

Given these dynamics, it is an urgent priority for hospitals who treat Medicare patients to ensure their policies and practices provide those patients with high-quality and clinically appropriate dietary options. Emerging high-quality epidemiologic evidence strengthens the case for prioritizing minimally processed, whole foods in institutional settings. Large prospective cohort studies and updated systematic reviews have found that higher intake of ultra-processed foods is associated with increased risks of cardiovascular disease, type 2 diabetes, and all-cause mortality. For example, an updated 2025 dose–response meta-analysis found a 15% higher risk of all-cause mortality among individuals with the highest ultra-processed food intake.

A growing body of peer-reviewed evidence further demonstrates that diet quality—not simply caloric adequacy—substantially affects cardiometabolic outcomes, mortality, and chronic disease progression. High consumption of sugar-sweetened beverages has been associated with increased risk of type 2 diabetes, cardiovascular disease, and mortality in large prospective cohort studies and meta-analyses. Similarly, ultra-processed foods, including sweetened beverages and processed meats, have been associated with increased risk of diabetes and cardiometabolic disease.

Conversely, higher intake of whole grains and fiber-rich foods have been associated with lower risk of type 2 diabetes and improved long-term health outcomes. Replacement analyses further demonstrate improved outcomes when sugar-sweetened beverages are replaced with water, coffee, or tea.

Read the entire CMS CCSQ memo in pdf format at the hyperlink, above.

https://thehill.com/policy/healthcare/5808929-healthcare-concerns-top-issue/

Health care polling as top issue for first time since 2020: Gallup
By Sophie Brams - March 31, 2026

Americans are more concerned about the availability and cost of health care than any other domestic issue, with it reclaiming the top spot for the first time since 2020, according to a new Gallup poll.

The poll, released Tuesday, found that 61 percent of the 1,000 adults surveyed said they worry a “great deal” about accessing and affording health care, while 23 percent expressed a “fair amount” of concern.

That is compared to 51 percent of respondents who said they were concerned a “great deal” about the economy and 50 percent who said the same about inflation — two issues that dominated public anxiety over the past several years, according to the survey.

Easing worries about the economy, inflation and Social Security meant health care reemerged as Americans’ leading concern, where it ranked consistently between 2015 and 2020 before being overtaken by economic issues during former President Biden’s term.

The percentage of people highly anxious about economic issues grew in the early months of President Trump’s second term but has since returned to 2024 levels, Gallup noted.

Those core issues were separated by just 1 percentage point in 2025, but the cost of health care now leads by 10 points, according to the survey.

The poll also found that what people were the most anxious about varied by political affiliation, with 80 percent of Democrats and 66 percent of independents expressing a “great deal” of concern about health care and 55 percent of Republicans saying they are greatly concerned with illegal immigration.

The poll was conducted March 2-17. It has a margin of error of plus or minus 4 percentage points.

The fresh polling comes as tens of millions of Americans are grappling with the rising cost of health care and insurance following the expiration of ObamaCare subsidies.

The enhanced premium tax credits, first enacted during the COVID-19 pandemic and later expanded under the Biden administration, expired at the end of 2025 over the objection of Democrats, resulting in higher out-of-pocket costs and fewer Americans enrolling in coverage.

The House passed legislation in January to extend the subsidies for three years, but negotiations have stalled in the Senate.

Separate West Health/Gallup polling conducted earlier this month found that many Americans have changed their habits to afford health care, with roughly one-third of 19,535 respondents cutting back on expenses elsewhere.