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SNF Fraud or Perverse Incentives? Hunterbrook Investigates Understaffing, Self-Reported STAR Ratings, and Medicare Dollars at Skilled Nursing Facilities Is it fraud — or is it just a perverse incentive? That question sits at the center of Hunterbrook Media's latest investigation into skilled nursing facilities (SNFs), and the answer, as Stacey Richter puts it, matters to self-insured employers and anyone else paying for healthcare. In this episode, Stacey speaks with Michelle Cera, PhD, investigative reporter at Hunterbrook Media, whose investigation — triggered by a tip from an overwhelmed elder abuse attorney — uncovered a pattern of systematic understaffing, self-reported CMS STAR rating manipulation, executive bonuses tied to expense-cutting, and related-party financial engineering that funnels Medicare and Medicaid dollars straight back to corporate, while the most vulnerable patients pay with their health and their lives. WHAT YOU'LL LEARN ✅ How for-profit SNF chains systematically recruit the sickest patients to maximize Medicare and Medicaid reimbursement, then staff below what those patients actually need — keeping the difference as profit and, in some cases, doubling executive bonuses in a single year ✅ How Hunterbrook analyzed millions of publicly available CMS data points across roughly 14,000 skilled nursing facilities, applying a UCSF-developed expected-hours formula tied to patient acuity, to quantify the gap between staffing hours billed and care hours actually provided ✅ Why CMS STAR ratings — the primary tool consumers use to choose nursing homes for loved ones — are largely informed by self-reported, unaudited facility data, and how former employees described manipulation of those ratings as rampant ✅ How related-party transactions allow SNF chains to route Medicare and Medicaid dollars through owned subsidiaries for goods and services like pharmacy, equipment, and insurance — with CMS flagging the overcharges as disallowed costs but lacking any mechanism to recoup them ✅ How a 2024 CMS final rule establishing a federal minimum of 3.48 HPRD (hours per resident day) and a 24/7 on-site registered nurse requirement was ultimately rescinded after industry lobbying — and what that rescission reveals about regulatory capture in the SNF sector ✅ Four concrete policy fixes: codify federal minimum staffing hours adjusted for patient acuity, strengthen reporting standards and auditing so no quality metric is entirely self-reported, create a recoupment mechanism for flagged related-party overcharges, and reform STAR ratings so consumers can distinguish independently verified data from self-reported data WHY THIS MATTERS Right now, Stacey argues, we are endlessly trying to keep up with thousands of profit-extracting geniuses and creating mazes of complexity to regulate actors who have no societal construct keeping them in check. The SNF sector is a case study in what happens when there is no agreed-upon definition of harm — when perverse incentives are just incentives. These are taxpayer, employer, and patient co-insurance dollars potentially going into someone's pocket while a patient is simultaneously being hurt. The 65-plus population is growing, the market is expanding, and — as Hunterbrook's research shows — the model that works from a profit perspective is to take sicker patients, cut the highest-paid staff first, and grade your own homework so no one notices. That playbook, once proven, spreads fast. === LINKS ===
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Steven Seyedin discusses radiation therapy. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41558]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Steven Seyedin discusses radiation therapy. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41558]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Steven Seyedin discusses radiation therapy. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41558]
00:08 — Ryan Cooper is senior editor of The American Prospect and author of How Are You Going to Pay for That?: Smart Answers to the Dumbest Question in Politics. 00:33 — Justin Salhani is a journalist who's been reporting from Beirut since 2011. 00:45 — Dr. Gloria Tavera, a UCSF gastroenterology fellow active in the Committee of Interns and Residents SEIU union since 2021. The post Israeli Military Strikes Continue in Lebanon; Plus, How the Closure of the Strait of Hormuz Impacts Americans; And, UCSF Interns and Residents Protest New Union Contract appeared first on KPFA.
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Jonathan Chou discusses targeted therapies. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41563]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Spencer Behr discusses PSMA PET and functional imaging. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41557]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Jonathan Chou discusses targeted therapies. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41563]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Spencer Behr discusses PSMA PET and functional imaging. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41557]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Jonathan Chou discusses targeted therapies. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41563]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Spencer Behr discusses PSMA PET and functional imaging. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41557]
Intelligence Unshackled: a show for people with brains (a Brainjo Production)
Henry Mahncke is the CEO of Posit Science and the creator of BrainHQ, the most researched brain training platform in the world. A neuroscientist who did his PhD with Michael Merzenich, considered the father of adult brain plasticity, Henry has spent two decades translating brain plasticity science into tools that actually improve brain health. In this conversation, we dig into why most brain training criticism misses the point, what the largest clinical trials really show, and why the future of brain health looks a lot like the evolution of physical fitness. In this episode: 00:00 — Introduction and Henry's background (PhD with Merzenich at UCSF, McKinsey, founding Posit Science) 07:00 — Brain training vs. cognitive training: why the distinction matters 09:00 — Brain plasticity as the driver of brain health, and why cognitive reserve is really just brain health 13:00 — Maladaptive brain plasticity: how aging actively degrades information processing through negative plasticity 18:00 — How BrainHQ exercises are designed: adaptive speed and accuracy training from psychophysics 24:00 — The transfer and generalization debate: does brain training improve real-world function? 28:00 — Clinical trial evidence: the Mayo/USC RCT, the ACTIVE study, and 300+ published papers 34:00 — The pharmaceutical analogy: why asking "does brain training work?" is the wrong question 37:00 — Who is brain training for? From post-concussive disorder to Tom Brady 44:00 — Brain training as physical exercise: the case for everyone at every age 46:00 — Real-world brain plasticity activities: racquet sports, musical instruments, foreign languages 51:00 — Josh's Brainjo origin story and what music training does for the brain 55:00 — The loss of skill learning in modern life and education 58:00 — The "dark ages" of brain health and where the field is headed To submit a question for us to answer on the podcast, go to brainjo.academy/question. To subscribe to the free Better Brain Fitness newsletter, join us when we record live, and get our Guide and Checklist to essential blood tests and nutrients, go to: betterbrain.fitness. Click here to order Dr. Wood's book, "The Stimulated Mind." Click here to pre-order Dr. Turknett's upcoming book, "The Genius and the Impostor" Intro and Outro music composed and produced by Julienne Ellen.
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. David Oh discusses immunotherapy. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41562]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. David Oh discusses immunotherapy. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41562]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. David Oh discusses immunotherapy. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41562]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Stacey Kenfield, ScD, discusses diet and exercise. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41555]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Will Chen discusses PET-directed radiation for Oligometastatic Disease. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41559]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Arpita Desai discusses metastatic hormone sensitive prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41560]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Arpita Desai discusses metastatic hormone sensitive prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41560]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Stacey Kenfield, ScD, discusses diet and exercise. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41555]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Will Chen discusses PET-directed radiation for Oligometastatic Disease. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41559]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Arpita Desai discusses metastatic hormone sensitive prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41560]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Will Chen discusses PET-directed radiation for Oligometastatic Disease. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41559]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Stacey Kenfield, ScD, discusses diet and exercise. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41555]
What if everything you were taught about building wealth was designed for someone else's benefit, not yours? High-income professionals, especially doctors, lawyers, and entrepreneurs, are earning hundreds of thousands of dollars a year and still ending up financially behind, buried in debt, crushed by taxes, and handing their futures over to Wall Street. In this episode of the Real Estate Investor Growth Network, Jen Josey sits down with Buck Joffrey, MD, a former cosmetic surgeon turned serial entrepreneur who has been involved in over $2 billion in real estate transactions, to expose exactly why the traditional financial playbook is quietly failing the highest earners in the room and what to do instead. Buck breaks down his mathematical wealth formula, a momentum-based framework built around mass, velocity, and leverage, that gives high-income professionals a repeatable system for building real, lasting passive income. He shares the pivotal moment that made him walk away from a prestigious surgical career at UCSF, why syndication investments unlock a world most people never even know exists, and how the short-term rental loophole gives busy professionals access to powerful depreciation benefits without requiring a real estate professional designation. He also gets candid about the operators who got crushed by rising interest rates and how to vet a deal and a sponsor without getting burned. This episode is essential listening for any high-income earner who feels like they are working harder than ever but not getting ahead financially. Whether you are a doctor, a business owner, or a seasoned investor looking to scale smarter, Buck's framework will shift how you think about money, passive income, and the power of investing like the ultra-wealthy. The window to position yourself in quality assets is open right now, and this conversation will show you exactly how to walk through it. 5 Powerful Takeaways The Mathematical Wealth Formula Revealed: Buck's three-variable framework of mass, velocity, and leverage gives high-income professionals a clear, repeatable system to multiply wealth without relying on luck or timing the market. Why Earning $500,000 a Year Can Still Leave You Broke: Between student loan debt, lifestyle inflation, and W2 tax exposure, high earners are often the most financially vulnerable, and Buck explains precisely why and how to fix it. The Short-Term Rental Loophole High-Income Earners Are Missing: Buck confirms that STR investing allows busy professionals to access real estate depreciation benefits typically reserved for full-time real estate professionals, creating a massive tax advantage hiding in plain sight. How to Vet a Syndication Sponsor Without Getting Burned: In a market where even respected operators have taken losses, Buck outlines the non-negotiable questions to ask about a deal's location, job growth, construction pipeline, and the operator's track record before writing a single check. Accredited Investor Access Changes Everything: Once you understand what becomes available at the accredited investor level, from private equity to pre-IPO opportunities to syndications, you realize the ultra-wealthy are not smarter, they simply play in a different game, and Buck shows you how to enter it. About the Guest Buck Joffrey, MD, is a former cosmetic and neurosurgeon who trained at the University of California, San Francisco, before making a bold pivot into entrepreneurship, real estate, and financial education. He has been involved in over $2 billion in real estate transactions and has spent more than a decade helping high-income professionals break free from the golden handcuffs of a high salary with nothing to show for it. Buck is the host of the Wealth Formula Podcast, one of the longest-running financial education shows for professionals, and the number one international bestselling author of 7 Secrets of Eternal Wealth. His unique superpower is reverse-engineering the strategies of the ultra-wealthy and translating them into a practical, math-backed framework that busy professionals can actually implement. Resources and Websites Mentioned wealthformula.com Wealth Formula Podcast, available on YouTube and all major podcast platforms reignmastermind.com therealjenjosey.com 00:00 REIGN Podcast Intro 00:59 Guest Proof STR Tips 04:44 Meet Buck Joffrey 07:03 Surgeon to Entrepreneur 10:02 Money Mindset for High Earners 11:59 Real Estate and Syndications 15:08 Why High Income Stays Broke 17:14 Mathematical Wealth Formula 21:40 Women and Wealth Gap 23:18 Passive Income Options 23:57 Tax Strategy With Rentals 25:34 Accredited Investor Access 27:57 Syndication Explained Simply 28:50 Vetting Operators And Deals 32:33 Book And Podcast Future 35:19 Badass Book Pick 36:39 Advice And Long Game 37:33 Drive And Aspirations 38:59 Systems And Success 40:46 Where To Find Dr Buck 41:44 Final Wrap And Subscribe
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Ivan de Kouchkovsky discusses radioligand therapy. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41561]
As part of the 2026 Developmental Disabilities Conference, Robin Wilson-Beattie, Disability and Sexual and Reproductive Health Educator, discusses sexual health. Series: "Developmental Disabilities Update" [Health and Medicine] [Show ID: 41469]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Ivan de Kouchkovsky discusses radioligand therapy. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41561]
As part of the 2026 Developmental Disabilities Conference, Robin Wilson-Beattie, Disability and Sexual and Reproductive Health Educator, discusses sexual health. Series: "Developmental Disabilities Update" [Health and Medicine] [Show ID: 41469]
As part of the 2026 Developmental Disabilities Conference, Robin Wilson-Beattie, Disability and Sexual and Reproductive Health Educator, discusses sexual health. Series: "Developmental Disabilities Update" [Health and Medicine] [Show ID: 41469]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Ivan de Kouchkovsky discusses radioligand therapy. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41561]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Julian Hong discusses radiation therapy. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41551]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Julian Hong discusses radiation therapy. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41551]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Julian Hong discusses radiation therapy. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41551]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Samuel Washington discusses active surveillance of prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41549]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Peter Carroll discusses biochemical recurrence. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41556]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, the UCSF Patient Services Committee and California Prostate Cancer Coalition present a panel discussion on resources. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41554]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Peter Carroll discusses biochemical recurrence. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41556]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, the UCSF Patient Services Committee and California Prostate Cancer Coalition present a panel discussion on resources. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41554]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Samuel Washington discusses active surveillance of prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41549]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Samuel Washington discusses active surveillance of prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41549]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, the UCSF Patient Services Committee and California Prostate Cancer Coalition present a panel discussion on resources. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41554]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Peter Carroll discusses biochemical recurrence. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41556]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Carissa Chu discusses surgery for prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41550]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Carissa Chu discusses surgery for prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41550]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Matthew Cooperberg discusses focal therapy. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41553]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. I-Chow (Joe) Hsu discusses brachytherapy. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41552]
As part of the 2026 UCSF Patient Conference on Prostate Cancer, Dr. Terence Friedlander discusses optimizing bone health. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 41540]
Listen to our latest podcast as Dr Brian Feeley and Dr Nirav Pandya breakdown the decision making that goes into treating ACL tear, meniscus injuries, and rotator cuff pathology in our latest podcast.
The only pediatric doctor formulated probiotic and supplement for kids: microbiome-magic The test for your child's microbiome: https://www.tinyhealth.com/If you've ever done everything "right" for your kids, clean eating, good hygiene, regular checkups, and still watched them struggle with cavities, ear infections, big tonsils, or just getting sick over and over again, this conversation is going to stop you in your tracks. Because the answer isn't in the toothbrush. It isn't in the antibiotic. It starts in the gut, and it shows up everywhere.What You'll Learn in This Episode:Why tooth decay in children is not a hygiene problem but a sign that the immune system and microbiome are out of balance, and what to do about it.How the oral microbiome and gut microbiome are in constant conversation, and why disrupting one affects the other, and ultimately the whole child.What early warning signs like mouth breathing, enlarged tonsils, frequent ear infections, and bad breath are actually telling you about your child's gut health.Which foundational lab tests Dr. Song recommends for children and teenagers, including why fasting insulin and cholesterol are two markers most pediatricians aren't checking but probably should be.The three microbiome champion food categories most kids are missing, and the key nutrients almost every child needs more of, even the healthy eaters.About Dr. Elisa Song: Dr. Elisa Song is a Stanford, NYU, and UCSF-trained integrative pediatrician, pediatric functional medicine expert, and the founder of Healthy Kids Happy Kids. She is the author of the Healthy Kids Happy Kids book and the creator of a clinically backed pediatric supplement line designed to fill both the nutritional and microbiome gaps in children's diets. She is also the Chief Medical Officer for Tiny Health, a microbiome testing company with age-appropriate reference ranges for babies and children. Dr. Song has spent over two decades helping families prevent and reverse chronic childhood illness by getting to the root.Key Insights:One of the most important reframes in this conversation is that cavities are not a brushing problem. They are a terrain problem. When the oral microbiome is off, when pathogenic bacteria are overpowering the beneficial ones, decay follows. And the oral microbiome doesn't exist in isolation. It's in constant crosstalk with the gut, the immune system, the sinuses, and even the developing brain. So when a child has a mouthful of cavities despite a health-conscious home, the question to ask isn't what are they eating. It's what is their body doing with it.Dr. Song and Dr. Carver also dig into something that doesn't get nearly enough airtime in conventional pediatrics, which is that chronic childhood symptoms like enlarged tonsils, mouth breathing, frequent ear infections, and recurring congestion are immune signals, not just developmental quirks. They are the body asking for help. And in many cases, the gut microbiome is the place to start looking for answers.Perhaps the most powerful moment in this episode is the conversation around autoimmunity starting decades before a diagnosis. Research shows that autoimmune antibody rates in teenagers have been rising steadily since the 1980s. These kids don't have a disease yet, but their immune system is already raising its hand. The encouraging news, and both Dr. Song and Dr. Carver are clear about this, is that we can course correct. Supporting the gut microbiome, optimizing nutrition, and calming the nervous system are not just wellness trends. They are genuinely preventive medicine.Resources Mentioned: [Placeholder: Add any books, tools, or links mentioned in this episode, including Dr. Song's book Healthy Kids Happy Kids and the Tiny Health microbiome test.]Connect With Dr. Elisa Song: Website: healthyhappykids.com Instagram: @healthykids_happykidsThe only pediatric doctor formulated probiotic and supplement for kids: microbiome-magic Test your child's microbiome: https://www.tinyhealth.com/FREE How to Reverse Gum Disease in 6 Weeks: ReverseGumDiseaseConnect With Dr. Rachaele Carver: Join the 6-Week Gum Disease CourseBook Your Personalized ConsultationSubscribe and Leave a Review: If this episode spoke to something you've been carrying as a parent, please share it with a mom who needs to hear it, and if you haven't already, subscribe and leave a review so more families can find this conversation.Disclaimer: This podcast is for educational purposes only. Information discussed is not intended for diagnosis, curing, or prevention of any disease and is not intended to replace advice given by a licensed healthcare practitioner. Opinions from guests are their own, and this podcast does not condone or endorse opinions made by guests. This podcast and its guests may have direct or indirect financial interests associated with products mentioned.
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