Literature Review

Wound care fraud: key insights for healthcare providers in 2026 JD Supra; by Lynette Byrd; 8/21/26 The U.S. Department of Justice (DOJ) and U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) are prioritizing wound care fraud enforcement in 2026. Healthcare providers are facing scrutiny under the False Claims Act and Anti-Kickback Statute, with audits and investigations leading to substantial liability (among other consequences) in many cases. ... Allegations of wound care-related health care fraud can take many different forms. ... While it is critical that elderly patients (including hospice patients and other terminally ill patients) receive appropriate care, there are limits to what is considered appropriate when billing Medicare or Medicaid for wound care. ...

CMS hospice payment suspensions slamming vendors Hospice News; by Jim Parker; 8/21/26 ... CMS earlier this year began suspending Medicare payments to hundreds of hospices allegedly due to suspected fraud. ... Evidence indicates that some legitimate hospices were caught up in the dragnet due to patients being discharged for valid reasons, such as a revocation of the benefit, moving out of a provider’s service area or transfer to another hospice. ... These regulatory actions have had a ripple effect on vendors, according to a DME company CEO that spoke to Hospice News on background. “These hospice agencies are being suspended. They’re not getting paid,” the DME CEO told Hospice News. “If they’re not getting paid, their employees are not getting paid. DME providers like us are not getting paid. Pharmacies are not getting paid. Any other contractor they have is not getting paid.” This has placed some vendor businesses in peril, and some of them have been considering layoffs of their own, another DME provider ... told Hospice News, “We’ve been trying to keep everybody on board, keep them employed, keep them paid for as long as we possibly can.”

Hospice Wage Index, the Final Rule, and the signals CMS is sending | part one Teleios Collaborative Network (TCN); pocast hosted by Chris Comeaux with Annette Kiser and Judi Lund Person The 2027 Hospice Final Rule is more than a reimbursement update—it’s a window into where Centers for Medicare & Medicaid Services (CMS) believes hospice care needs to go next. In Part One, host Chris Comeaux sits down with hospice regulatory experts Annette Kiser and Judi Lund Person to look beyond the numbers and “read the tea leaves” in CMS’s latest rule.  They unpack what hospice leaders need to understand about the Hospice Election Statement Addendum, the growing scrutiny of unrelated services and non-hospice Medicare spending, telehealth reporting, and the Service and Spending Variation Index (SSVI).  As Judi explains, CMS’s commentary and responses to industry feedback can reveal as much about the agency’s direction as the regulations themselves.

4 huge Medicare pay reforms are part of new bipartisan House bill American Medical Association (AMA); by Tanya Albert Henry; 8/11/26 With more physician Medicare pay cuts proposed for 2027, a new comprehensive, bipartisan bill introduced in the U.S. House of Representatives would finally make structural changes that are needed to prevent those cuts and create a payment system that helps ensure that America’s seniors have access to quality, value-based healthcare. The AMA-supported Patients First Act (H.R. 9693) addresses four core reforms that the AMA and organized medicine have long sought from Washington. If passed, the bill would:

CMS: Hospice claim rejections due to admission and election date editLeading Age; 8/12/26 A Centers for Medicare and Medicaid Services (CMS) change request prevents overpayments of long-term hospice care that took effect April 1, 2026. Unfortunately, the edit is now impacting hospice institutional claims. Medicare Administrative Contractors, Wellpoint Federal, CGS, and Palmetto, sent notices to providers that claims are failing system edits when the transfer date is populated as the admission date. The claims return with edits U5565 and U5566, preventing successful claim creation/submission. The MACs are overriding the edit and allowing the impacted claims to process. 

Sixth Circuit clarifies Medicare safe harbor for hospice providers in landmark coverage decision JD Supra; by Jason Bring and Bill Dombi; 8/5/26 Key Takeaways

Hospice groups ‘disappointed’ by 2027 Final Rule Hospice News; by Jim Parker; 8/3/26 Hospice organizations are expressing “disappointment” following the release of the U.S. Centers for Medicare & Medicaid Services’ (CMS) hospice final rule for 2027. A chief sticking point was the 2.3% base rate increase, which was less than the 2.4% the agency originally proposed. Members of industry trade groups contend that this is an insufficient amount in today’s economy and cost environment. ... New for 2027, the Service and Spending Variation Index (SSVI) includes a scoring system using nine claims-based measures, each representing different aspects of hospice utilization as well as non-hospice spending. This is designed to identify hospices in need of increased transparency and oversight. CMS established the SSVI amid the agency’s concerns over non-hospice spending in particular. The Alliance, LeadingAge and the National Partnership for Healthcare and Hospice Innovation (NPHI) opposed the SSVI in comments on the proposed rule.

Columbus Foundation grant to support Wexner Heritage Village hospice music therapy program Columbus Jewish News; by Noell Wofgram Evans; 7/31/26   The transition to a hospice can be emotional, stressful and scary. Zusman Community Hospice at Wexner Heritage Village was recently awarded a grant from the Columbus Foundation to help reduce the negative feelings that can be connected with that transition. The $25,000 grant will establish a Hospice Music Therapy Program, a new program that joins their pet therapy and aromatherapy care components which accompany traditional hospice services. Sophia Elias, director of development at Wexner Heritage Village, told the Columbus Jewish News, “The grant will support year-long access to a board-certified music therapist who will provide approximately six to seven visits each week.”

6th Cir. vacates district court ruling against Medicare hospice Bloomberg Law; by Ganny Belloni; 7/26/26 

Sterling Hospice home to close, expected to reopen under new ownership KWQC-6, Sterling, IL; by KWQC Staff; 7/22/26 The Rock River Hospice & Home is closing Aug.1, officials announced Wednesday. The organization, which has been serving people throughout the Sauk Valley area for over 40 years, is closing due to longstanding financial challenges, officials said in a media release. “Changes in healthcare reimbursement, increasing operating costs, and other economic pressures have made it increasingly difficult for standalone hospice providers to remain financially sustainable,” officials said. However, officials said care will continue to be available in the community. 

H.R.9703 - Improving access to transfusion care for hospice patients act of 2026 U.S. Congress.gov, House Ways and Means Committee; sponsored by Rep. Debbie Dingell (D-MI-6); bill introduced 7/15/26 H.R. 9703: To require the Center for Medicare and Medicaid Innovation to test allowing blood transfusions to be paid separately from the Medicare hospice all-inclusive per diem payment.

Savings in Medicare hospice payments for care provided in nursing homes U.S. HHS-OIG; Project Number OEI-02-26-00180; 7/15/26 The fixed daily rates that Medicare pays hospices for routine home care provided in a nursing home include personal care services.  However, nursing homes are already required to provide personal care services to their residents.  Paying the hospice the full routine home care rate that covers personal care services when these services are already required from the nursing home can undermine the efficiency of Medicare payments and add to the incentives that bad actors have to exploit the program.  This review will determine Medicare payments for routine home care provided to hospice beneficiaries in nursing homes, estimate potential cost savings from reducing the payment to address the inefficiency in the payment structure, and examine practices of hospices with a high percentage of their beneficiaries in nursing homes.