Literature Review

National trends in types of hospice disenrollment among older adults with dementia, 2012–2019 Journal of the American Geriatrics Society; by Lauren J. Hunt, Siqi Gan, Krista L. Harrison, Melissa D. Aldridge, Claire Ankuda, W. John Boscardin, Alexandra K. Lee, and Alexander K. Smith; 9/15/26 Key Points

Update to 2026 hospice payment rate correctionFrom CMS; by Guest Editor Judi Lund Person; 9/9/26CMS has informed us on September 9, 2026 that there is a correction notice in clearance right now, which hopefully will be out soon. The change is minor and the wage index issue was across all payment systems, not just hospice. 

LeadingAge, coalition partners tell CMS: don’t punish good Medicare providers LeadingAge, Washington, DC; contact Colleen Knudsen; 8/31/26 In a joint sign-on letter led by LeadingAge, the association of nonprofit and mission-driven providers of aging services and submitted to the Centers for Medicare and Medicaid Services (CMS) today, a coalition of 19 partners representing hospitals, physician and clinician practices, post-acute and long-term care providers, home health and hospice agencies, suppliers, and the beneficiaries served by all, warn the agency that the proposed changes to Medicare provider enrollment provisions, included in the Calendar Year (CY) 2027 Home Health Prospective Payment System (PPS) Rule, risk penalizing legitimate providers and could result in limiting beneficiary access to care. The coalition fundamentally supports CMS’ responsibility to protect the Medicare Trust Fund and beneficiaries from fraud, waste, and abuse. However, ...

Mercy Hospice change in operator created conditions that posed ‘immediate jeopardy’ to patient well-being, state regulators say The Journal; by Jessie Bowman; 9/1/26 The ownership transition of Durango’s hospice program created serious problems in patient care and organizational oversight, according to state inspections that found multiple deficiencies and twice determined patients were at immediate risk of serious harm or death. In October 2025, the for-profit arm of the national CommonSpirit Health system – CommonSpirit Health at Home – took over ownership of the Mercy Hospice program. CommonSpirit assured the community the quality of care would not decline as a result of the transition. ... However, in May, the Colorado Department of Public Health and Environment conducted two concurrent relicensing inspections that found the ownership transition created system-wide deficiencies that led to clinical care practices and poor organizational oversight that put patient health and safety at serious risk. 

Alliance submits comments in response to CY 2027 Home Health Proposed Rule National Alliance for Care at Home, Alexandria, VA; Press Release; 9/1/26 The National Alliance for Care at Home (the Alliance) has submitted comments in response to the Centers for Medicare & Medicaid Services’ Calendar Year (CY) 2027 Home Health Prospective Payment System Rate and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program Updates proposed rule.  The letter notes that the Alliance appreciates that, for the first time since CY 2022, CMS proposes a full annual payment update, does not propose to apply a new permanent adjustment, [and ...] However, the comment also emphasizes that these decisions do not undo the harm already built into the payment rate, nor do they do enough to protect access to care across the country. 

CMS says it has blocked or recovered more than $1.6 billion in suspect Medicare lab payments VIN News, Washington, DC; by Reven Rosenfeld; 8/28/26 The Trump administration has blocked or clawed back more than $1.6 billion in potentially improper Medicare laboratory payments since President Donald Trump took office and removed 157 laboratory providers from the program over alleged billing fraud, officials with the Centers for Medicare & Medicaid Services said Friday.

Week ahead in health care: MedPAC meeting with in-person audience Inside Health Policy; by Jessica Karins and Amy Lotven; 8/28/26 The Medicare Payment Advisory Commission (MedPAC) will meet Thursday (Sept. 3) and Friday (Sept. 4) virtually and, for the second time since the COVID-19 pandemic, with limited in-person public seating.

California and the federal government battle over hospice fraud, as victims lose coverage and care Regional Media News, Los Angeles, CA; by wrnnews.com; 8/26/26At 71 and a few years into retirement, Linda Henry felt like she was in good health, and only went to her doctor in Southern California for the occasional checkup. So it was a shock when she found out in 2024 that she had been enrolled in hospice, a specialized end-of-life care usually provided to people with six months or less to live. A Medicare worker told her the system said she had heart failure. Henry was a victim of rampant fraud in the hospice industry, a problem that’s been especially extreme in California, ... Henry believes her Medicare number was stolen after a healthcare payment portal that services insurances was hit by a cyberattack. She found out about her hospice enrollment in September 2024 after her doctor billed Medicare for an allergy test and was denied. Soon, other claims were being returned unpaid.

American Society of Nephrology (ASN) comments on CY2027 ESRD PPS QIP Requests for Information (RFIs)American Society of Nephrology; official comments letter from ASN to Centers for Medicare & Medicaid Services; 8/24/26RE: CMS-1846 Medicare Program; CY2027 Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System, Acute Kidney Injury Dialysis (AKI) Payment, and ESRD Quality Incentive Program On behalf of the more than 37,000,000 Americans living with kidney diseases and the 22,000 nephrologists, scientists, and other kidney health care professionals who comprise the American Society of Nephrology (ASN) ... In this letter, ASN provides feedback on the following requests of information (RFIs): ...

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. ...

Modernizing payment integrity in an era of systemic fraud MedCityNews; by Christian Bass; 8/21/26 Across the United States, Medicaid and Medicare fraud cases are surfacing with increasing frequency — and scale. From improper billing and undocumented services to upcoding and duplicate claims, these cases span federal programs and state-administered Medicaid plans. Once perceived as isolated misconduct, these cases are now being exposed as a systemic challenge, revealing vulnerabilities in reimbursement oversight that affect payers, regulators, and ultimately taxpayers. ... Gaps in reimbursement oversight and recovery will only widen, unless plans modernize how they detect, investigate, and recoup improper payments. Organizations that respond quickly will be positioned to manage the financial and regulatory headwinds.

READOUT: FinCEN holds engagement to eliminate hospice fraud in CaliforniaU.S. Treasure Financial Crimes Enforcement Network, Los Angeles, CA; 8/19/26 On August 17, the U.S. Department of the Treasury’s Financial Crimes Enforcement Network (FinCEN) convened law enforcement and financial institutions for an engagement on health care benefits fraud, including the exploitation of hospice care services. Participants discussed new and emerging health care fraud schemes targeting federal and state health insurance programs, associated financial typologies and red flag indicators, and opportunities to boost awareness around hospice care fraud. Additionally, FinCEN held a training session for law enforcement on August 18 on how to use Bank Secrecy Act data to combat fraud. These engagements build on FinCEN’s work to counter fraud in partnership with the White House Task Force to Eliminate Fraud. 

HHS decertifies Kentucky organ procurement organization Hazard Herald, Hazard, KY; by an Appalachian Newspapers Staff Report; 8/15/26 The U.S. Department of Health and Human Services announced in a statement Aug. 5 that it has decertified Network For Hope, the federally designated organ procurement organization serving Kentucky and parts of Indiana, Ohio and West Virginia. According to the statement, the move comes after multiple federal reviews found "persistent safety failures despite extensive oversight and despite Network for Hope having been provided repeated opportunities to correct them." The failures, according to the statement, put prospective organ donors and patients awaiting lifesaving transplants at risk.