Literature Review

CMS proposed rule locks in lower prices and fosters innovation for the Medicare Drug Price Negotiation Program CMS.gov; Press Release; 6/12/26 A new proposal from the Centers for Medicare & Medicaid Services (CMS) would establish a permanent framework for the Medicare Drug Price Negotiation Program (“Negotiation Program”), creating a more transparent and sustainable process for lowering drug costs for millions of Medicare beneficiaries. The proposed rule would also create greater long-term certainty for drug manufacturers that participate in negotiations. It includes policies for negotiating and renegotiating high-cost, single-source drugs beginning with initial price applicability year 2029, while continuing to support innovation and strengthen the program.

Health brief: Hospice purge ensnares legitimate providers Washington Post Intelligence; by Megan R. Wilson; 6/15/26

Vance’s fraud task force is sweeping up legitimate small businesses The Washington Post, Washington, DC; by Isaac Arnsdorf; 6/15/26 The vice president and other officials have downplayed evidence of collateral damage in their crackdown on fraudulent hospices. In April, when the Trump administration began suspending about 800 hospices in the Los Angeles area suspected of fraud, a small local agency started accepting patients from the affected providers. The owner never thought he would be next. ... “The Trump administration is taking a pretty aggressive tactic here, but the downside is you’re often going to catch up legitimate actors because you’re not really taking the time to do your due diligence,” said Hillary Loeffler, vice president of policy and regulatory affairs for the National Alliance for Care at Home, an industry group, who worked on hospice issues at CMS until 2025.

MedPAC Executive Summary - June 2026 report MedPAC; 6/15/26As part of its mandate from the Congress, each June the Commission reports on potential improvements to Medicare payment systems and issues that affect the Medicare program, including changes to health care delivery and the market for health care services. The six chapters of our June 2026 report cover the following topics:

California proposes emergency hospice regulations amid fraud Hospice News; by Holly Vossel; 6/9/26 The California Department of Public Health has proposed emergency hospice regulations to address fraudulent activity in the state. The proposal includes the establishment of more stringent criteria to better evaluate the legitimacy of new hospice businesses. ...  Among other provisions, the proposed emergency regulations included new adoptions of standardized definitions related to hospice services and marketing information, license applications, as well as for staff personnel qualifications and responsibilities of administrators, attending physicians and authorized care providers.

What to know about recent federal actions involving state Medicaid program integrity KFF; by Jessica Mathers and Elizabeth Hinton; 6/9/26 The Department of Health and Human Services (HHS) has also taken nationwide and state-specific action in the Medicaid program, including:

Nevada Health Authority announces pause on new state licenses for hospice, home-health services as officials investigate possible Medicaid fraud KLAS, Las Vegas; by Linsey Lewis; 6/5/26 The Nevada Health Authority announced a temporary pause on new state licenses for hospice and home-health services as state officials conduct “extensive” reviews of all Medicaid-enrolled hospice and home-health providers to identify cases of fraud. The pause on new state licenses for hospice and home-health providers and a moratorium on new enrollments for Nevada Medicaid come as fraud in the hospice and home-healthcare spaces garners national attention with high-dollar crimes from Medicaid and Medicare billing activities and fake operations.

Dr. Joan Teno exposes the hidden problems with hospice ratings and quality scores | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Dr. Joan Teno; 6/3/26 What if the hospice ratings patients and families rely on don’t tell the full story?   In Part One of this thought-provoking conversation, renowned hospice researcher and policy expert Dr. Joan Teno joins Chris Comeaux and Cordt Kassner to unpack the hidden flaws within today’s hospice quality measurement systems. Drawing on more than 30 years of experience shaping hospice and palliative care policy, Dr. Teno explains why many publicly reported quality measures may fail to capture the true experiences of patients and families.  She discusses the challenges of transparency, the unintended consequences of current reporting systems, concerns about fraud and oversight, and how artificial intelligence could help transform the future of hospice quality measurement. 

West Coast fraud and AI: DOJ expands healthcare fraud enforcement into technology-driven markets JDSupra | Proskauer Health Care Law Brief; by Devin Cohen, Lara Feder, Matthew Westbrook; 6/3/26 On April 30, 2026, the Department of Justice (“DOJ”) announced the creation of the West Coast Health Care Fraud Strike Force, a coordinated enforcement initiative focused on healthcare fraud in Arizona, Nevada, and Northern California. ... DOJ’s announcement also reflects the government’s growing focus on technology-enabled healthcare fraud risks. ... In its announcement, DOJ specifically highlights recent prosecutions involving digital health executives and healthcare technology-related fraud schemes in Northern California and Arizona.

A month’s worth of fraud busting in 10 notable quotesHealthExec; by Dave Pearson; 5/26/26This month, HHS’s Senior Medicare Patrol program designated the first workweek of June Medicare Fraud Prevention Week... Ahead of June 1 to 5, here’s a timeline of fraud-related news, views and developments as captured in concise statements uttered or written in May. [See article for all 10 quotes.]

CMS myth vs. fact: what hospice and home health providers need to know about the new Medicare enrollment moratoria JD Supra; by Stephen Angelette, Mary Canavan, Simran Nijjar, Ross Sallade, Elizabeth Tucker, and Deja Williams; 5/26/26 [Responding to the CMS nationwide six-month moratoria barring new Medicare enrollments for hospice and home health agencies (HHAs), effective May 13 ... ] Any actions that trigger an initial Medicare enrollment are prohibited during the moratoria. This can include changes in ownership, new practice locations, additions of provider types, or other transactions requiring a new enrollment application.In this alert, we address common myths surrounding the moratoria and key considerations for providers during the six-month period. Guest Editor's Note, Judi Lund Person: Review this guidance for application to your hospice or home health planning, including mergers, acquisitions, and establishment of new practice locations or new branches.   

CMS enrollment moratoria: CHOW implications for home health and hospice transactions JD Supra; by Arnall Golden Gregory LLP; 5/22/26 ... Although the announcement has significant implications for new HHA and hospice entrants, the practical impact on change of ownership (“CHOW”) transactions is narrower: the moratoria should affect only those CHOWs that are treated as new initial enrollment under the Medicare “36-month rule.” ...Key Takeaways

GAO makes MedPAC appointments U.S. Government Accountability Office (GAO), Washington, DC; Press Release; 5/22/26 Orice W. Brown, Acting Comptroller General of the United States and head of the U.S. Government Accountability Office (GAO), today announced the appointment of the Chair, Vice Chair, and two new members to the Medicare Payment Advisory Commission (MedPAC). She also reappointed two current members. MedPAC advises Congress on payments to providers in Medicare’s traditional fee-for-service program and to health plans participating in the Medicare Advantage program. ...